经静脉拔除导线严重并发症的相关危险因素

Risk factors for severe complications of transvenous lead extraction

目的探讨患者经静脉拔除心内电极导线过程中常见的严重并发症及其相关危险因素。方法回顾性分析2012年1月1日至2017年12月31日所有在北京大学人民医院经静脉拔除心内导线患者资料,根据是否发生并发症将这些患者分为并发症组与对照组,记录所有患者的性别、年龄、植入器械类型,初次导线植入时间、拔除导线总数、拔除右心房导线数目、拔除右心室导线数目,拔除植入型心律转复除颤器(ICD)导线数目,拔除左心室导线数目,拔除方法等变量。并应用单因素和多因素Logistic回归分析这些变量是否与严重并发症的发生相关。结果研究期间共完成经静脉导线拔除手术922例,共拔除各类导线1832根(其中右心房导线751根,右心室导线917根,左心室导线74根,除颤导线90根)。共发生严重并发症16例(包括急性心脏压塞12例,需要外科手术的急性三尖瓣反流3例,急性肺动脉栓塞1例)。本组资料严重并发症的发生率为1.7%。单因素和多因素Logistic回归分析表明拔除右心房导线数目(OR=3.056,95%CI1.174~7.958,P=0.022)、初次导线植入时间(OR=1.102,95%CI1.029~1.180,P=0.005)是经静脉拔除导线发生严重并发症的危险因素(OR=1.102,95%CI1.029~1.180,P=0.005;OR=3.056,95%CI1.174~7.958,P=0.022)。结论在经静脉起搏导线拔除工作中,急性心脏压塞是最常见的严重并发症。右心房导线数目增加、初次导线植入时间延长是围术期发生严重并发症的危险因素。

Objective To find out the risk factors of major complications with transvenous lead extraction involving cardiovascular implantable electronic devices.Methods All patients who underwent transvenous lead extraction in heart center of People’s Hospital between Jan 1st 2012 and Dec 31st 2017 were included in this study.The patients were divided into complication group and control group.All medical records were reviewed and data pertaining to patient demographics,type of devices,dates from original device implantation,number of all total leads extracted,number of right atrial leads extracted,number of right ventricular leads extracted,number of implantable cardioverter defibrillator(ICD)leads extracted,left ventricular leads extracted,and extraction methods were recorded.Univariate and multivariate logistic regression analysis were used to identify,the risk factors for severe complications during transvenous extraction procedures.Results A total of 1 832 leads were removed from 922 patients during studying period.Among them,751 right atrial leads,917 right ventricular leads,74 left ventricular leads,and 90 ICD leads were removed.Sixteen severe complications occurred,including 12 tamponade,3 acute tricuspid valve regurgitation requiring emergency open-heart surgery,and 1 pulmonary embolism needing embolectomy.Both univariate and multivariable logistic regression analysis showed that the number of right atrial leads removed and the duration of initial device implantation were risk factors for serious complications(OR=3.056,95%CI 1.174-7.958,P=0.022;OR=1.102,95%CI 1.029-1.180,P=0.005,respectively).Conclusions Tamponade is the commonest major complication with lead extraction procedures.Number of right atrial leads and time after leads implantation are risk factors for severe perioperative complication of lead extraction.