Department of Cardiology, Medical University of Lublin, Lublin, Poland.
2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland.
J Cardiovasc Electrophysiol. 2024 Oct;35(10):1981-1996. doi: 10.1111/jce.16398. Epub 2024 Aug 11.
Extraction of a broken lead fragment (BLF) has received scant attention in the literature.
Retrospective analysis was to compare the effectiveness of different approaches and tools used for BLF removal during 127 procedures.
A superior approach was the most popular (75.6%), femoral (15.7%) and combined (8.7%) approaches were the least common. Of 127 BLFs 78 (61.4%) were removed in their entirety and BLF length was significantly reduced to less than 4 cm in 21 (16.5%) or lead tip in 12 (9.4%) cases. The best results were achieved when BLFs were longer (>4 cm) (62/93 66.7% of longer BLFs), either in the case of BLFs free-floating in vascular bed including pulmonary circulation (68.4% of them) but not in cases of short BLFs (20.0% of short BLFs). Complete procedural success was achieved in 57.5% of procedures, the lead tip retained in the heart wall in 12 cases (9.4%) and short BLFs were found in 26.0%, whereas BLFs >4 cm were left in place in four cases (3.1%) of procedures only. There was no relationship between approach in lead remnant removal and long-term mortality.
(1) Effectiveness of fractured lead removal is satisfactory: entire BLFs were removed in 61.4% (total procedural success-57.5%, was lower because five major complications occurred) and BLF length was significantly reduced in 26.0%. (2) Among the broken leads, leads with a long stay in the patient (16.3 years on average), passive leads (97.6%) and pacemaker leads 92.1% are significantly more common, but not ICD leads (only 7.9% of lead fractures) compared to TLE without lead fractures. (3) Broken lead removal (superior approach) using a CS access sheath as a "subclavian workstation" for continuation of dilatation with conventional tools deserves attention. (4) Lead fracture management should become an integral part of training in transvenous lead extraction.
在文献中，对折断的导联碎片（BLF）的提取关注甚少。
回顾性分析比较了在 127 例操作中使用不同方法和工具去除 BLF 的效果。
最受欢迎的方法是最佳方法（75.6％），股静脉（15.7％）和联合（8.7％）方法则是最不常见的方法。在 127 个 BLF 中，78 个（61.4％）被完整取出，BLF 长度明显减少至 4cm 以下的有 21 个（16.5％）或导联尖端的 12 个（9.4％）。当 BLF 较长（>4cm）时，效果最佳（93 个长 BLF 中有 62 个，占 66.7％），无论是游离于血管床（包括肺循环）中的 BLF，还是较短的 BLF。在 57.5％的操作中完全成功，12 个（9.4％）导联尖端保留在心脏壁中，26.0％的操作中发现短 BLF，而仅 4 个（3.1％）操作中留下>4cm 的 BLF。在遗留导联去除的方法与长期死亡率之间没有关系。
（1）折断导联去除的有效性是令人满意的：75.6％的患者可完全取出 BLF（总程序成功率为 57.5％，较低是因为发生了 5 种主要并发症），26.0％的患者 BLF 长度明显减少。（2）在折断的导联中，患者体内留置时间较长（平均 16.3 年）、被动导联（97.6％）和起搏器导联（92.1％）更为常见，而 ICD 导联（仅有 7.9％的导联折断）则不如无导联折断的 TLE 常见。（3）使用 CS 接入鞘作为“锁骨下工作站”，以继续使用传统工具进行扩张的折断导联去除（最佳方法）值得关注。（4）应将导联折断的管理作为经静脉导联提取培训的一个组成部分。
