经静脉途径拔除植入心律起搏装置导线25例临床体会
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摘要
目的:回顾性分析和总结经静脉途径拔除植入心律起搏装置(CIED)导线的方法和体会。方法:25例CIED患者(导线断裂3例、感染22例)的47根导线经静脉途径成功拔除,其中6例导线徒手拔除,15例应用锁定钢丝和扩张鞘拔除,1例运用Evolution机械鞘拔除,3例经下腔静脉途径拔除;22例患者于对侧植入新的心律起博装置,2例患者无植入新的起搏装置指证,1例患者因感染性心内膜炎积极治疗无效死亡。结果:所有导线均完全拔除,术中术后均未发生严重并发症。结论:经静脉途径拔除CIED导线是根治心律起博装置导线相关问题的重要措施,科学、有效的运用多种器械和技术在复杂病例的应用中十分重要。
Objective:A retrospective analysis and summary of the method and experience of lead extraction of cardiac implantable electronic device(CIED)by intravenous route.Method:A total of 47 leads from 25 patients with CIED(3 with broken leads and 22 with infections)were successfully removed via intravenous route.Among them,6 cases were pulled out by hand and 15 cases were removed by locking wire and extension sheath,1 by evolution mechanical sheath and 3 by inferior vena cava.In 22 patients,new pacemaker devices were implanted in the contralateral side,2 patients had no indication of new pacemaker device,and 1 patient died due to infective endocarditis.Result:All of the leads were completely removed and no severe complications occured.Conclusion:It is an important measure to remove CIED lead via intravenous route.Application of various instruments and technologies is helpful in these complex cases.
Objective:A retrospective analysis and summary of the method and experience of lead extraction of cardiac implantable electronic device(CIED)by intravenous route.Method:A total of 47 leads from 25 patients with CIED(3 with broken leads and 22 with infections)were successfully removed via intravenous route.Among them,6 cases were pulled out by hand and 15 cases were removed by locking wire and extension sheath,1 by evolution mechanical sheath and 3 by inferior vena cava.In 22 patients,new pacemaker devices were implanted in the contralateral side,2 patients had no indication of new pacemaker device,and 1 patient died due to infective endocarditis.Result:All of the leads were completely removed and no severe complications occured.Conclusion:It is an important measure to remove CIED lead via intravenous route.Application of various instruments and technologies is helpful in these complex cases.
引文
[1] Baddour LM,Epstein AE,Erickson CC,et al.Update on cardiovascular implantable electronic device infections and their management:a scientific statement from the American Heart Association[J].Circulation,2010,121(3):458-477.
[2] 中国生物医学工程学会心律分会.心律植入装置感染与处理的中国专家共识2013 [J].临床心电学杂志,2013,22(4):241-253.
[3] Greenspon AJ,Patel JD,Lau E,et al.16-year trends in the infection burden for pacemakers and implantable cardioverter-defibrillators in the United States 1993 to 2008[J].J Am Coll Cardiol,2011,58(10):1001-1006.
[4] 郭继鸿.英国2014年《心律植人装置感染的诊断、预防和处理指南》的解读[J].中华心脏与心律电子杂志,2015,3(2):16-22.
[5] Bilgutay AM,Jensen NK,Schmidt WR,et al.Incarceration of transvenous pacemaker electrode.Removal by traction[J].Am Heart J,1969,77(3):377-379.
[6] 王方正,马坚,何梅先,等.经静脉拔除心内膜导线:目前认识和处理建议[J].中华心律失常学杂志,2002,6(5):263-269.
[7] Klug D,Wallet F,Lacroix D,et al.Local symptoms at the site of pacemaker implantation indicate latent systemic infection[J].Heart,2004,90(8):882-886.
[8] Baddour LM,Epstein AE,Erickson CC,et al.A summary of the update on cardiovascular implantable electronic device infections and their management:a scientific statement from the American Heart Association[J].J Am Dent Assoc,2011,142(2):159-165.
[9] 李学斌,段江波,王龙,等.应用激光鞘拔除电极导线(附五例报道)[J].中国心脏起搏与心电生理杂志,2015,29(5):445-448.
[10] 陈进,李学斌,王龙,等.经静脉途径拔除起搏电极导线的影响因素[J].中国心脏起搏与心电生理杂志,2012,26(6):489-491.
[11] Hauser RG,Katsiyiannis WT,Gornick CC,et al.Deaths and cardiovascular injuries due to device-assisted implantable cardioverter-defibrillator and pacemaker lead extraction[J].Europace,2010,12(3):395-401.
[12] Hussein AA,Wilkoff BL.Lead Extraction Considerations for the Referring Cardiologist[J].Cardiol Rev,2017,25(1):17-21.
[13] Ribeiro S,Leite L,Oliveira J,et al.Transvenous removal of cardiac implantable electronic device leads[J].Rev Port Cardiol,2015,34(12):739-744.
[14] 李赐恩,宋卫锋,王徐乐,等.起搏器感染后再次植入原起搏器和植入新起搏器的安全性比较分析[J].临床心血管病杂志,2017,33(4):353-355.
[2] 中国生物医学工程学会心律分会.心律植入装置感染与处理的中国专家共识2013 [J].临床心电学杂志,2013,22(4):241-253.
[3] Greenspon AJ,Patel JD,Lau E,et al.16-year trends in the infection burden for pacemakers and implantable cardioverter-defibrillators in the United States 1993 to 2008[J].J Am Coll Cardiol,2011,58(10):1001-1006.
[4] 郭继鸿.英国2014年《心律植人装置感染的诊断、预防和处理指南》的解读[J].中华心脏与心律电子杂志,2015,3(2):16-22.
[5] Bilgutay AM,Jensen NK,Schmidt WR,et al.Incarceration of transvenous pacemaker electrode.Removal by traction[J].Am Heart J,1969,77(3):377-379.
[6] 王方正,马坚,何梅先,等.经静脉拔除心内膜导线:目前认识和处理建议[J].中华心律失常学杂志,2002,6(5):263-269.
[7] Klug D,Wallet F,Lacroix D,et al.Local symptoms at the site of pacemaker implantation indicate latent systemic infection[J].Heart,2004,90(8):882-886.
[8] Baddour LM,Epstein AE,Erickson CC,et al.A summary of the update on cardiovascular implantable electronic device infections and their management:a scientific statement from the American Heart Association[J].J Am Dent Assoc,2011,142(2):159-165.
[9] 李学斌,段江波,王龙,等.应用激光鞘拔除电极导线(附五例报道)[J].中国心脏起搏与心电生理杂志,2015,29(5):445-448.
[10] 陈进,李学斌,王龙,等.经静脉途径拔除起搏电极导线的影响因素[J].中国心脏起搏与心电生理杂志,2012,26(6):489-491.
[11] Hauser RG,Katsiyiannis WT,Gornick CC,et al.Deaths and cardiovascular injuries due to device-assisted implantable cardioverter-defibrillator and pacemaker lead extraction[J].Europace,2010,12(3):395-401.
[12] Hussein AA,Wilkoff BL.Lead Extraction Considerations for the Referring Cardiologist[J].Cardiol Rev,2017,25(1):17-21.
[13] Ribeiro S,Leite L,Oliveira J,et al.Transvenous removal of cardiac implantable electronic device leads[J].Rev Port Cardiol,2015,34(12):739-744.
[14] 李赐恩,宋卫锋,王徐乐,等.起搏器感染后再次植入原起搏器和植入新起搏器的安全性比较分析[J].临床心血管病杂志,2017,33(4):353-355.