A large single-center clinical trial of transvenous lead extraction

目的 经静脉导线拔除术是心血管植入型电子器械(CIED)感染处理的核心技术.本文将单中心在导线拔除术以及工具选择方法的经验及临床应用做一总结.方法 本研究自2007年至2014年,分为两个阶段:第1阶段2007年1月至2013年5月,第2阶段2013年6月至2014年12月.共纳入北京大学人民医院心脏中心患者501例,拔除1 032根导线.分别比较两个阶段中导线拔除术的成功率、并发症、电极类型、使用工具等.结果 第1阶段2007年1月至2013年5月,纳入患者252例,共拔除导线509根.其中,右心房电极导线189根(37.1％),右心室电极导线272(53.4％),左心室电极导线24根(4.7％),除颤线圈24根(4.7％).平均植入时间为27(0.3～360.0)个月.导线拔除成功率98.9％,严重并发症6例,死亡2例(0.79％).第2阶段2013年6月至2014年12月,共纳入患者249例,共拔除导线523根.其中,右心房电极导线201根(38.4％),右心室电极导线240(45.9％),左心室电极导线35根(6.7％),除颤线圈47根(9.0％).平均植入时间为38(0.4～490.0)个月.导线拔除成功率100％,严重并发症3例(1.2％),无死亡病例.第2阶段中,Evolution机械鞘组拔除导线77根,并发症1例(1.3％).Snare组拔除导线400根,严重并发症1例(0.25％).结论 经静脉导线拔除术是CIED感染处理安全有效的方法,其伴有严重并发症的发生风险.合理选择特殊工具有助于提高导线拔除术的安全性和有效性.结合中心经验,下腔装置Snare可以作为导线拔除术的首选工具.Objective Transveneous lead extraction is the basic therapy in the management of cardiovascular implantable electrical device (CIED) infection.In this report,we presented our initial experience in transvenous lead extraction and the method of tools-choosing.Methods From January 2007 to March 2014,the study was divided into two periods:period one (January 2007-Maych 2013),period two (June 2013-December 2014).1 032 leads in 501 patients were removed.The indications for extraction were based on the recommendations of the heart rhythm society.The success rate,complication,lead types and special tools,etc were compared.Results During the period one(Jan 2007-May 2013),509 leads in 252 patients were removed,in which atrial lead 189(37.1％),right ventricular lead 272(53.4％),left ventricular lead 24(4.7％),defibrillator coil 24(4.7％).Implantation duration was 27 (0.3-360.0)months,Success rate 98.9％,major complication in 6 cases,2 death (1.7％).During the period two(June 2013-December 2014),523 leads in 249 patients were extracted,in which atrial leads 201(38.4％),right ventricular leads 240(45.9％),left ventricular leads 35(6.7％),defibrillator coils 47(9.0％).Implantation duration was 38 (0.4-490.0)months.Success rate was 100％,major complication in 1 case,0 deaths.In period two,77 leads were extracted by Evolution mechanical dilator sheath(Cook Medical),major complication 1 case(1.3％).Four hundreds leads were extracted by Needle's Eye Snare(Cook Medical),major complication in 1 case (0.25％).Conclusion The transvenoues lead extraction is effective in management of CIED infection.It companied the risk of major complication.The reasonable tools-choosing will increase the safety and efficacy.Needle Eye Snare could be the primary choice in lead extraction.北京市科学技术委员会首都临床特色应用研究中国科技核心期刊(ISTIC)4244-2491