Mekary Wissam, Ibrahim Rand, Westerman Stacy, Shah Anand, Bhatia Neal K, Merchant Faisal M, El-Chami Mikhael F
Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia.
Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia.
Heart Rhythm. 2025 May;22(5):1307-1311. doi: 10.1016/j.hrthm.2024.08.063. Epub 2024 Sep 6.
Lead-related venous stenosis and occlusion can complicate the insertion or replacement of transvenous leads in patients with cardiac implantable electronic devices (CIEDs). A possible solution is to tunnel the lead from the contralateral vasculature to the ipsilateral generator. Procedural complications and long-term outcomes remain unclear with this technique.
We sought to assess outcomes of tunneled transvenous leads.
We retrospectively identified all patients who underwent transvenous CIED lead tunneling to a contralateral pocket at our institution between 2014 and 2024. Clinical characteristics, indications for lead implantation, postoperative complications, and long-term outcomes were collected.
We identified that 27 patients underwent transvenous lead tunneling at our institution. Most patients were men (20, 74%) with a mean age of 68.8 ± 18.3 years. Most patients had nonischemic cardiomyopathy (16, 59%) with a mean ejection fraction of 29.3% ± 11.3%. The tunneled leads were coronary sinus leads (20, 74%), followed by defibrillator leads (5, 18.5%) and right ventricular pacing leads (2, 7.4%). Implantation procedures were primarily for device upgrade (18), lead revisions (8), or de novo lead placement (1). No postoperative complications were seen. Patients were followed for a mean of 2.2 ± 1.4 years. One tunneled defibrillator lead (3.7%) had low shock impedance 3 years after implantation, which was monitored and did not require an intervention.
In patients with ipsilateral venous occlusion, contralateral lead tunneling appears to be an effective and safe approach to manage patients with CIEDs and occluded ipsilateral subclavian veins.
与铅相关的静脉狭窄和闭塞会使心脏植入式电子设备（CIED）患者经静脉导线的插入或更换变得复杂。一种可能的解决方案是将导线从对侧血管系统隧道至同侧发生器。这项技术的手术并发症和长期结果仍不清楚。
我们试图评估经静脉隧道导线的结果。
我们回顾性确定了2014年至2024年期间在我们机构接受经静脉CIED导线隧道至对侧囊袋的所有患者。收集了临床特征、导线植入指征、术后并发症和长期结果。
我们确定在我们机构有27例患者接受了经静脉导线隧道术。大多数患者为男性（20例，74%），平均年龄为68.8±18.3岁。大多数患者患有非缺血性心肌病（16例，59%），平均射血分数为29.3%±11.3%。隧道导线为冠状窦导线（20例，74%），其次是除颤器导线（5例，18.5%）和右心室起搏导线（2例，7.4%）。植入手术主要用于设备升级（18例）、导线修订（8例）或初次导线放置（1例）。未见术后并发症。患者平均随访2.2±1.4年。一根隧道除颤器导线（3.7%）在植入后3年出现低电击阻抗，进行了监测且无需干预。
对于同侧静脉闭塞的患者，对侧导线隧道术似乎是管理CIED患者和闭塞同侧锁骨下静脉的一种有效且安全的方法。
