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经皮静脉内永久性起搏器/除颤器导线取出术:单中心经验。

Percutaneous Extraction of Transvenous Permanent Pacemaker/Defibrillator Leads-A Single-Center Experience.

机构信息

Department of Cardiology, Ondokuz Mayıs University School of Medicine, Samsun 55139, Turkey.

出版信息

Medicina (Kaunas). 2024 Aug 21;60(8):1360. doi: 10.3390/medicina60081360.

Abstract

: The number of cardiac pacemakers being used has increased in recent decades, and this increase has led to a rise in device-related complications, requiring percutaneous device extraction. Our aim was to present our single-center clinical experience in percutaneous lead extractions. : We analyzed an observational retrospective cohort study of 93 patients for the transvenous removal of a total of 163 endocardial leads. We evaluated the device details, indications, lead characteristics, extraction methods, complications, reimplantation procedure, follow-up data, effectiveness, and safety. : Patients' mean age was 68.6 ± 11.6 years. Lead extraction indications were pocket infection in 33 (35.5%), lead dysfunction in 33 (35.5%), and system upgrade in 21 (23%) cases, and lead endocarditis in 6 (6%) cases. The duration from implantation to extraction time was a detected median of 43 (24-87) months. The most common retracted lead type was the RV defibrillator lead (62%), and the lead fixation type was active for one hundred (61%) patients. A new device was inserted in 74 (80%) patients, and the device type was most commonly a CRT-D (61%). Patients were followed up at a median of 17 (8-36) months, and 18 patients (19%) died at follow-up. Complete procedural success was obtained in 78 (84%) patients, and clinical procedural success was obtained in 83 (89%) patients. Procedural failure was detected in 15 (16%) patients. Major and minor complications were detected in 10 (11%) and 6 (6.5%) patients, respectively. The most common minor complication was pocket hematoma. : Our experience suggests that transvenous lead extraction has a high success rate with an acceptable risk of procedural complications. The simple manual traction method has a high rate of procedural success, despite a high dwell time of the lead.

摘要

: 近几十年来,心脏起搏器的使用数量有所增加,这导致与器械相关的并发症增加,需要进行经皮器械取出。我们旨在介绍我们在经皮导线取出方面的单中心临床经验。: 我们分析了一项回顾性观察队列研究,该研究纳入了 93 例患者,总共进行了 163 次心内膜导线的经静脉取出。我们评估了器械细节、适应证、导线特征、取出方法、并发症、再植入程序、随访数据、有效性和安全性。: 患者的平均年龄为 68.6 ± 11.6 岁。导线取出的适应证包括 33 例(35.5%)的囊袋感染、33 例(35.5%)的导线功能障碍、21 例(23%)的系统升级和 6 例(6%)的导线心内膜炎。从植入到取出的时间中位数为 43(24-87)个月。最常见的缩回导线类型为 RV 除颤器导线(62%),导线固定类型为主动固定的有 100 例(61%)。74 例(80%)患者中插入了新的器械,最常见的器械类型是 CRT-D(61%)。患者的中位随访时间为 17(8-36)个月,随访时 18 例(19%)患者死亡。78 例(84%)患者获得了完全程序成功,83 例(89%)患者获得了临床程序成功。15 例(16%)患者出现程序失败。10 例(11%)和 6 例(6.5%)患者分别出现了主要和次要并发症。最常见的轻微并发症是囊袋血肿。: 我们的经验表明,经皮导线取出具有较高的成功率,程序并发症的风险可以接受。尽管导线留置时间较长,但简单的手动牵引方法具有较高的程序成功率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5993/11356401/18ebc7ae6474/medicina-60-01360-g001.jpg

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本文引用的文献

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Safety and efficacy of transvenous lead extraction of very old leads.非常陈旧心内导线经静脉途径安全有效拔除。
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Lead Removal Without Extraction Tools: A Single-Center Experience.无需拔牙工具的铅去除:单中心经验
Braz J Cardiovasc Surg. 2019 Aug 27;34(4):458-463. doi: 10.21470/1678-9741-2018-0275.
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Reimplantation After Lead Removal.导线移除后的再植入
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