Schwartzman D, Nallamothu N, Callans D J, Preminger M W, Gottlieb C D, Marchlinski F E
Clinical Electrophysiology Laboratory, Philadelphia Heart Institute, Presbyterian Medical Center of Philadelphia, Pennsylvania 19104, USA.
J Am Coll Cardiol. 1995 Sep;26(3):776-86. doi: 10.1016/0735-1097(95)00244-X.
This study sought to document postoperative complications attributable to nonthoracotomy defibrillation lead systems in a large cohort.
The incidence of postoperative complications specifically associated with nonthoracotomy defibrillation lead systems is unknown.
Postoperative lead-related complications were evaluated in 170 patients with a nonthoracotomy defibrillation lead system who were followed up for a mean (+/- SD) of 17 +/- 12 months. Each system incorporated one or more intravascular leads. In 117 patients (69%), the system incorporated a subcutaneous defibrillation patch. All implantations were performed in an operating room by cardiothoracic surgeons. Defibrillation thresholds were measured at implantation, before hospital discharge (mean 3 +/- 2 days) and at 4 to 18 weeks after implantation. Patients were evaluated every 2 to 3 months after implantation or as indicated by clinical exigency.
Twenty-seven patients (15.9%) were diagnosed with a lead-related complication that either extended the initial hospital period or led to a second hospital admission. Complications included endocardial lead or subcutaneous defibrillation patch dislodgment in eight patients (4.7%), which was diagnosed between 2 and 345 days after implantation; endocardial or subcutaneous patch lead fracture in six (3.5%), which was diagnosed between 53 and 600 days after implantation; subcutaneous patch mesh fracture in one, which was diagnosed at 150 days after implantation; subclavian vein thrombosis in three (1.8%), which was diagnosed at 2 to 50 days after implantation; and unacceptably elevated defibrillation threshold (within 5 J of maximal device output) in nine (5.3%), which was documented at one of the two postimplantation evaluations in eight patients or at the time of failure to terminate a spontaneous ventricular tachycardia in one. Seventeen of the 27 patients required reoperation for correction of their complication. In addition, system infection requiring complete explantation occurred in seven other patients (4.1%) at an interval from implantation ranging from 14 to 120 days.
Postoperative complications related to a nonthoracotomy defibrillation lead system were common and frequently required reoperation for correction. The rate of system explantation due to infection was also significant. Postoperative defibrillation testing and vigilant outpatient follow-up evaluation are necessary to ensure normal lead function.
本研究旨在记录一大群患者中与非开胸除颤导联系统相关的术后并发症。
与非开胸除颤导联系统具体相关的术后并发症发生率尚不清楚。
对170例采用非开胸除颤导联系统的患者进行了术后导联相关并发症评估，平均随访时间（±标准差）为17±12个月。每个系统包含一根或多根血管内导联。117例患者（69%）的系统包含一个皮下除颤贴片。所有植入手术均由心胸外科医生在手术室进行。在植入时、出院前（平均3±2天）以及植入后4至18周测量除颤阈值。植入后每2至3个月对患者进行评估，或根据临床紧急情况进行评估。
27例患者（15.9%）被诊断出与导联相关的并发症，这些并发症要么延长了最初的住院时间，要么导致再次入院。并发症包括8例（4.7%）心内膜导联或皮下除颤贴片移位，在植入后2至345天被诊断；6例（3.5%）心内膜或皮下贴片导联断裂，在植入后53至600天被诊断；1例皮下贴片网状物断裂，在植入后150天被诊断；3例（1.8%）锁骨下静脉血栓形成，在植入后2至50天被诊断；9例（5.3%）除颤阈值升高到不可接受的程度（在最大设备输出的5焦耳范围内），8例患者在两次植入后评估中的一次记录到，1例在未能终止自发性室性心动过速时记录到。27例患者中有17例需要再次手术纠正并发症。此外，7例其他患者（4.1%）在植入后14至120天发生了需要完全取出装置的系统感染。
与非开胸除颤导联系统相关的术后并发症很常见，且经常需要再次手术纠正。因感染导致系统取出的发生率也很高。术后除颤测试和密切的门诊随访评估对于确保导联功能正常是必要的。
