激光导管拔除心脏起搏除颤导线的临床应用研究

Pacemaker/ICD lead extraction with the excimer laser sheath： a single center experience

目的 研究旨在分析激光导管拔除心脏起搏除颤导线的安全性和有效性.方法回顾性分析美国明尼苏达大学退役军人医疗中心自2008年3月至2009年12月间用激光导管拔除起搏除颤导线的连续16例患者,通过对患者的一般临床状况、基础疾病、心功能状态、起搏除颤导线拔除原因、导线状况及并发症等进行分析,了解激光拔除起搏除颤导线的方法、步骤、安全性和有效性,并总结手术经验及减少并发症的方法.结果 16例患者均为男性,年龄54～82（67.4 ±9.1）岁,多数患者均有严重的心脏疾病,左室射血分数为20%～60%（36.4±13.4）%.16例中,9例为拔除导线的Ⅰ类适应证,7例患者为Ⅱ类适应证.导线置入的时间为3～251（73.9±62.9）个月,其中时间最长者达251个月.共拔除导线31根,其中25根使用激光导管.所有患者均成功拔除导线,没有并发症.其中1例患者心房导线被拉断,经股静脉送入抓取工具后将导线残段经股静脉拉出,没有并发症发生;另1例患者成功拔除了3根导线,但在升级BiV-埋藏式心脏自动复律除颤器手术时导致冠状窦夹层及心包积液,未进行心包穿刺而稳定出院.结论初步研究资料表明,应用激光导管等综合方法和工具经静脉拔除心脏起搏除颤导线是安全、有效的.

Objective The aim of this study is to investigate the safety and effectiveness of Excimer laser-assisted lead extraction. Methods Consecutive lead extraction in 16 patients using the excimer laser sheath from Veterans Administration Medical Center, University of Minnesota between March 2008 and December 2009 were analyzed retrospectively. The clinical characteristics including basic disease, cardiac function, indication and reason for lead removal, lead characteristic, and complication were summarized. Results Thirty one leads （ laser sheaths were used in 25 leads） in 16 patients [mean age （67.4 ±9. 1 ）years, range 54-82 years] were extracted. All leads were extracted successfully without complication.Most patients had severe heart diseases with left ventricular ejection fraction of 20% -60% （mean 36. 4% ±13.4% ）. Mean implant time was （73.9 ±62. 9）months （range 3 -251 months）. Nine patients had Class Ⅰ indications for lead extraction, 7 patients for Class Ⅱ indications. Atrial lead fractured in one patient during lead extraction, the remaining part of the lead was taken out from femoral vein by a snare-catheter apparatus. Another patient developed CS dissection and small pericardium perfusion during LV lead implantation （upgrade to BiV-ICD ） post successful lead extraction and patient discharged without complication. Conclusion Our single center experience suggests that Excimer Laser Sheath Lead Removal System is safe and effective in extracting pacemaker and ICD leads.