Zheng Wencheng, Ze Feng, Yang Dandan, Li Ding, Zhou Xu, Yuan Cuizhen, Li Xuebin
Department of Cardiac Electrophysiology, Peking University People's Hospital, Peking University, Beijing 100044, P.R. China.
Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100044, P.R. China.
Med Int (Lond). 2021 Aug 4;1(4):11. doi: 10.3892/mi.2021.11. eCollection 2021 Sep-Oct.
Following the removal of cardiovascular implantable electronic devices (CIEDs), reassessment of the need for a new device is vital. Some patients may have exhibited an improvement in rhythm or cardiac function and may thus no longer meet the guideline requirements for reimplantation. However, the long-term outcomes of non-systematic device reimplantation remain unknown. In the present study, it was hypothesized that the implantation of pacing systems in selected patients following lead extraction is safe. In order to confirm this hypothesis, a total of 854 patients (aged between 28 and 82 years) who underwent the removal of a CIED were enrolled in the present study and they were all reassessed to determine whether a new device following lead extraction was necessary. In order to determine which patients would undergo non-systematic device reimplantation, the standard guidelines, the criteria and the wishes of the patient were all taken into consideration. Patients remained device-free unless an adverse clinical event occurred that required reimplantation. The primary study endpoint was the rate of sudden death or reimplantation. Between January, 2014 and December, 2019, 854 consecutive patients underwent pacing system extraction, of whom 210 patients (24.6%) underwent non-systematic device reimplantation following careful reassessment (the non-reimplantation group). Among the 210 patients, 162 (77.1%) were fitted with pacemakers, 26 (12.4%) underwent cardiac resynchronization therapy or cardiac resynchronization therapy-defibrillator and 22 (10.5%) were implanted with a cardioverter-defibrillator. During a mean follow-up period of 40.4 months, 86 patients reached the primary endpoint of the study, including 54 out of 210 patients (25.7%) who experienced an adverse clinical event that required reimplantation and 32 out of 210 patients (15.2%) who experienced sudden death. Reimplantation of a new device was not required in ~25% of the patients. On the whole, the present study demonstrates that following pacing system removal, non-systematic device reimplantation associated with close surveillance is safe for selected patients.
在移除心血管植入式电子设备（CIED）后，重新评估是否需要植入新设备至关重要。一些患者的心律或心脏功能可能已有所改善，因此可能不再符合重新植入的指南要求。然而，非系统性设备重新植入的长期结果仍不明确。在本研究中，我们假设在选定患者中进行导线拔除后植入起搏系统是安全的。为了证实这一假设，本研究纳入了854例接受CIED移除的患者（年龄在28至82岁之间），并对他们进行了全面重新评估，以确定导线拔除后是否需要植入新设备。为了确定哪些患者将接受非系统性设备重新植入，我们综合考虑了标准指南、标准以及患者的意愿。除非发生需要重新植入的不良临床事件，患者将不再植入设备。主要研究终点是猝死率或重新植入率。在2014年1月至2019年12月期间，854例患者连续接受了起搏系统拔除，其中210例患者（24.6%）在经过仔细重新评估后接受了非系统性设备重新植入（非重新植入组）。在这210例患者中，162例（77.1%）植入了起搏器，26例（12.4%）接受了心脏再同步治疗或心脏再同步治疗除颤器治疗，22例（10.5%）植入了心律转复除颤器。在平均40.4个月的随访期内，86例患者达到了研究的主要终点，其中210例患者中有54例（25.7%）发生了需要重新植入的不良临床事件，210例患者中有32例（15.2%）发生了猝死。约25%的患者无需重新植入新设备。总体而言，本研究表明，在起搏系统拔除后，对选定患者进行密切监测并进行非系统性设备重新植入是安全的。
