准分子激光辅助肥胖患者导线拔除术的安全性和有效性：一项GALLERY亚组分析

Safety and Efficacy of Excimer Laser Powered Lead Extractions in Obese Patients: A GALLERY Subgroup Analysis.

作者信息

Schenker Niklas, Chung Da-Un, Burger Heiko, Kaiser Lukas, Osswald Brigitte, Bärsch Volker, Nägele Herbert, Knaut Michael, Reichenspurner Hermann, Gessler Nele, Willems Stephan, Butter Christian, Pecha Simon, Hakmi Samer

机构信息

Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, 20099 Hamburg, Germany.

Department of Cardiology, University Heart & Vascular Center Hamburg at the University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.

出版信息

J Clin Med. 2023 Jun 16;12(12):4096. doi: 10.3390/jcm12124096.

DOI:10.3390/jcm12124096

PMID:37373789

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10299542/

Abstract

BACKGROUND

The incidence of cardiac implantable electronic device (CIED)-related complications, as well as the prevalence of obesity, is rising worldwide. Transvenous laser lead extraction (LLE) has grown into a crucial therapeutic option for patients with CIED-related complications but the impact of obesity on LLE is not well understood.

METHODS AND RESULTS

All patients ( = 2524) from the GermAn Laser Lead Extraction RegistrY (GALLERY) were stratified into five groups according to their body mass index (BMI, <18.5; 18.5-24.9; 25-29.9; 30-34.9; ≥35 kg/m). Patients with a BMI ≥ 35.0 kg/m had the highest prevalence of arterial hypertension (84.2%, < 0.001), chronic kidney disease (36.8%, = 0.020) and diabetes mellitus (51.1%, < 0.001). The rates for procedural minor ( = 0.684) and major complications ( = 0.498), as well as procedural success ( = 0.437), procedure-related ( = 0.533) and all-cause mortality ( = 0.333) were not different between groups. In obese patients (BMI ≥ 30 kg/m), lead age ≥10 years was identified as a predictor of procedural failure (OR: 2.99; 95% CI: 1.06-8.45; = 0.038). Lead age ≥10 years (OR: 3.25; 95% CI: 1,31-8.10; = 0.011) and abandoned leads (OR: 3.08; 95% CI: 1.03-9.22; = 0.044) were predictors of procedural complications, while patient age ≥75 years seemed protective (OR: 0.27; 95% CI: 0.08-0.93; = 0.039). Systemic infection was the only predictor for all-cause mortality (OR: 17.68; 95% CI: 4.03-77.49; < 0.001).

CONCLUSIONS

LLE in obese patients is as safe and effective as in other weight classes, if performed in experienced high-volume centers. Systemic infection remains the main cause of in-hospital mortality in obese patients.

摘要

背景

心脏植入式电子设备（CIED）相关并发症的发生率以及肥胖症的患病率在全球范围内都在上升。经静脉激光导线拔除术（LLE）已成为CIED相关并发症患者的关键治疗选择，但肥胖对LLE的影响尚不清楚。

方法与结果

德国激光导线拔除登记处（GALLERY）的所有患者（n = 2524）根据其体重指数（BMI，<18.5；18.5 - 24.9；25 - 29.9；30 - 34.9；≥35 kg/m²）分为五组。BMI≥35.0 kg/m²的患者动脉高血压患病率最高（84.2%，P < 0.001）、慢性肾病患病率最高（36.8%，P = 0.020）以及糖尿病患病率最高（51.1%，P < 0.001）。各组之间的手术轻微并发症发生率（P = 0.684）、主要并发症发生率（P = 0.498）、手术成功率（P = 0.437）、手术相关死亡率（P = 0.533）和全因死亡率（P = 0.333）并无差异。在肥胖患者（BMI≥30 kg/m²）中，导线使用年限≥10年被确定为手术失败的预测因素（OR：2.99；95%CI：1.06 - 8.45；P = 0.038）。导线使用年限≥10年（OR：3.25；95%CI：1.31 - 8.10；P = 0.011）和废弃导线（OR：3.08；95%CI：1.03 - 9.22；P = 0.044）是手术并发症的预测因素，而患者年龄≥75岁似乎具有保护作用（OR：0.27；95%CI：0.08 - 0.93；P = 0.039）。全身感染是全因死亡率的唯一预测因素（OR：17.68；95%CI：4.03 - 77.49；P < 0.001）。