Dardari Mohamed, Iorgulescu Corneliu, Bataila Vlad, Deaconu Alexandru, Cinteza Eliza, Vatasescu Radu, Padovani Paul, Vasile Corina Maria, Dorobantu Maria
Department of Cardiology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Electrophysiology and Cardiac Pacing Lab, Clinical Emergency Hospital, 014461 Bucharest, Romania.
Reports (MDPI). 2023 Sep 7;6(3):41. doi: 10.3390/reports6030041.
Indications for cardiac implantable electronic devices (CIEDs) are increasing. Almost one-third of device-related infections are endocarditis. Transvenous lead extraction (TLE) has emerged as an effective and safe approach for treating device-related infections and complications. Multiple types of extraction tools are being used worldwide. Our goal is to evaluate the safety and effectiveness of TLE using non-powered extraction tools. The study included patients between October 2018 and July 2022 requiring TLE according to EHRA expert consensus recommendations on lead extraction. A total of 88 consecutive patients were included. Indications for TLE included device-related infections in 74% of the patients. Of those, 32% had device-related endocarditis with or without sepsis. Staphylococcus Aureus was the most frequent pathogen in patients with endocarditis and positive bacteremia, and 57% had negative bloodstream cultures. A total of 150 cardiac pacing and defibrillator leads were targeted for extraction. The mean dwell time for leads was 6.92 ± 4.4 years; 52.8% were older than 5 years, 15.8% were older than ten years, and the longest lead dwell time was 26 years. Patients' age varied between 18 and 98, with a mean age of 66 ± 16 years. Sixty-seven percent of patients were males. Using only non-powered extraction tools, we report 93.3% complete lead removal and 99% clinical success with partial extraction. We report no procedure-related death nor major complications. Minor complication incidence was 6.8%, and all complications resolved spontaneously. The 30-day mortality rate was 3.4%. TLE using non-powered extraction tools is safe and effective even without surgical backup on site.
心脏植入式电子设备（CIED）的适应证正在增加。几乎三分之一的与设备相关的感染是心内膜炎。经静脉导线拔除术（TLE）已成为治疗与设备相关的感染和并发症的一种有效且安全的方法。全球正在使用多种类型的拔除工具。我们的目标是评估使用无动力拔除工具进行TLE的安全性和有效性。该研究纳入了2018年10月至2022年7月期间根据欧洲心律协会（EHRA）关于导线拔除的专家共识建议需要进行TLE的患者。共纳入了88例连续患者。TLE的适应证包括74%的患者存在与设备相关的感染。其中，32%的患者患有与设备相关的心内膜炎，伴或不伴有败血症。金黄色葡萄球菌是心内膜炎和血培养阳性患者中最常见的病原体，57%的患者血培养阴性。总共150根心脏起搏和除颤导线被作为拔除目标。导线的平均留置时间为6.92±4.4年；52.8%的导线使用时间超过5年，15.8%的导线使用时间超过10年，最长的导线留置时间为26年。患者年龄在18至98岁之间，平均年龄为66±16岁。67%的患者为男性。仅使用无动力拔除工具，我们报告完全导线拔除率为93.3%，部分拔除的临床成功率为99%。我们报告无手术相关死亡或重大并发症。轻微并发症发生率为6.8%，所有并发症均自行缓解。30天死亡率为3.4%。即使现场没有手术后备支持，使用无动力拔除工具进行TLE也是安全有效的。
