Mills Eric W, Qin Dingxin, Mela Theofanie
Massachusetts General Hospital, Cardiac Arrhythmia Service, 55 Fruit St, Boston, MA, USA.
Curr Cardiol Rep. 2025 Sep 17;27(1):133. doi: 10.1007/s11886-025-02282-z.
Lead failure in cardiac implantable electronic devices (CIEDs) presents a critical challenge in clinical electrophysiology. These failures can result in inappropriate therapies, ineffective pacing, and even life-threatening outcomes. Despite technological advances in device design, transvenous leads remain an important source of complications.
Novel developments in lead extraction strategies including pre-procedure risk prediction instruments, estimation of short-term mortality after lead extraction procedure, use of new technologies including shock-wave lithotripsy to facilitate disruption of intravascular calcium, cardioneural ablation to avoid need for reimplantation of cardiac devices, and the use of leadless pacemaker/defibrillator systems followed transvenous extraction are discussed. This review explores the underlying mechanisms of lead failure, highlighting notable cases such as the Riata and Fidelis recalls, and discusses the complex decision-making process surrounding lead abandonment, extraction, or replacement.
心脏植入式电子设备（CIED）中的导线故障是临床电生理学面临的一项严峻挑战。这些故障可能导致不适当的治疗、无效起搏，甚至危及生命的后果。尽管设备设计取得了技术进步，但经静脉导线仍是并发症的重要来源。
讨论了导线拔除策略的新进展，包括术前风险预测工具、导线拔除术后短期死亡率的估计、使用新技术（如冲击波碎石术以促进血管内钙的破坏、心脏神经消融以避免再次植入心脏设备的需要）以及在经静脉拔除后使用无导线起搏器/除颤器系统。本综述探讨了导线故障的潜在机制，突出了如Riata和Fidelis召回等显著案例，并讨论了围绕导线废弃、拔除或更换的复杂决策过程。
