摘要
目的评估心脏植入式电子装置(CIED)出现导线故障时拔除及再植入的有效性和安全性,为临床实践提供科学依据。方法本研究拟收集2013年10月至2024年4月在北京大学人民医院因CIED导线故障入院进行导线管理的患者,分析其临床资料和手术数据,总结故障导线拔除与再植入的方法、并发症和成功率。结果共有218名患者因导线故障入院,其中导线磨损最常见,占导线故障的79.4%,其次是导线脱位(14.7%)和不明原因阈值升高(6.0%)。术前造影显示83.5%的患者植入静脉无狭窄或轻度狭窄,7.8%的患者静脉重度狭窄/闭塞。有81.2%的患者进行了故障导线拔除,共拔除284根导线,拔除导线的中位植入时间为48(24,84)个月,拔除的完全成功率为97.7%,1例(0.5%)患者出现主要并发症。拔除工具中圈套器占39.5%,其次是徒手/锁定探针38.4%。导线植入时间5年以上的患者绝大多数(92.2%)需使用高级的拔除工具(圈套器/激光鞘/机械鞘),起搏器患者更多使用圈套器拔除,而心脏转复除颤器患者更多使用激光鞘/机械鞘拔除。导线拔除后,83.9%的患者植入同类型装置,10.6%的患者进行了装置升级,2.8%的患者植入新型装置,2.3%的患者未再植入装置;同侧再植入率为72.5%,腋静脉植入率为41.1%;再植入成功率100%,1例围术期并发症(气胸)。结论进行故障导线拔除及再植入是安全可行的;建议对大多数患者的故障导线进行拔除;再植入时装置类型需再评估,非感染装置可同侧再植入,为减少导线磨损,建议采用腋静脉入路。
Objective To evaluate the effectiveness and safety of lead extraction and reimplantation when lead failure occurs in cardiac implantable electronic devices(CIED),providing a scientific basis for clinical practice.Methods This study aims to collect data from patients who were admitted for CIED lead management due to lead failure at Peking University People's Hospital between October 2013 and April 2024.The clinical data and surgical information of these patients will be analyzed to summarize the methods,complications,and success rates of lead extraction and reimplantation.Results A total of 218 patients were admitted due to lead failure,with lead wear being the most common issue(79.4%),followed by lead dislodgement(14.7%)and unexplained threshold increase(6.0%).Preoperative imaging showed that 83.5% of patients had no or mild stenosis in the implanted vein,while 7.8% had severe stenosis/occlusion.Lead extraction was performed in 81.2% of patients,with a total of 284 leads removed.The median implantation time of the extracted leads was 48(24,84)months,and the complete success rate of extraction was 97.7%,with one major complication(0.5%).Among the extraction tools used,snares accounted for 39.5%,followed by manual/locking stylets at 38.4%.The majority(92.2%)of patients with leads implanted for more than five years required advanced extraction tools(snares/laser sheaths/mechanical sheaths).Pacemaker patients more frequently used snares for extraction,while implantable cardioverter-defibrllator patients more often required laser/mechanical sheaths.After lead extraction,83.9% of patients received the same type of device,10.6% underwent device upgrades,2.8% were implanted with a new type of device,and 2.3% did not receive a new device.The same-side reimplantation rate was 72.5%,with axillary vein implantation accounting for 41.1%.The reimplantation success rate was 100%,with one perioperative complication(pneumothorax).Conclusion Lead extraction and reimplantation for failed leads are safe and feasible.It is recommended to remove failed leads in most patients.Device types should be reevaluated during reimplantation,and non-infected devices can be reimplanted on the same side.To reduce lead wear,the axillary vein approach is recommended.
作者
苑翠珍
郑方芳
昃峰
段江波
吴寸草
李鼎
李学斌
YUAN Cuizhen;ZHENG Fangfang;ZE Feng;DUAN Jiangbo;WU Cuncao;LI Ding;LI Xuebin(Department of Cardiology,Peking University People's Hospital,Beijing 100044,China)
出处
《中国心脏起搏与心电生理杂志》
2025年第4期344-349,共6页
Chinese Journal of Cardiac Pacing and Electrophysiology
基金
北京大学人民医院研究与发展基金(RDL2022-19)。
关键词
心脏植入式电子装置
导线故障
导线拔除
再植入
Cardiac implantable electronic devices
Lead failure
Lead extraction
Reimplantation
