移除心内起搏电极导线同期行永久心外膜起搏治疗感染性心内膜炎的可行性

Combined endocardial pacing lead removal and permanent epicardial pacing in one single procedure to treat infective endocarditis:the clinical evaluation

目的探讨在移除原心内感染起搏电极导线同期置入永久心外膜起搏电极导线，并行永久心外膜起搏治疗起搏依赖的起搏装置相关感染性心内膜炎的可行性，为此类疾病的治疗提供新思路。方法2012年2月1日至2014年2月1日北京大学人民医院收治起搏装置相关感染性心内膜炎患者6例，5例在移除心内膜感染起搏装置同期行永久心外膜起搏治疗。其中3例患者选择杂交技术同期行永久心外膜起搏治疗，2例患者选择体外循环下移除心内起搏电极导线及脉冲发生器并同期永久心外膜起搏治疗。结果5例感染性心内膜炎患者移除心内感染起搏电极导线及脉冲发生器同期行永久心外膜起搏治疗，患者均获治愈。1例杂交手术患者术中因部分电极残留及三尖瓣大量反流中转为开胸体外循环手术。术后随访1～12个月，无感染复发，起搏器工作良好。结论起搏依赖的起搏装置相关感染性心内膜炎患者移除心内感染电极导线及脉冲发生器后可以同期行永久心外膜起搏治疗。

Objective To investigate the feasibility and usefulness of implanting permanent epicardial pacemaker and performing epicardial pacing while removal the infected pacing system in a single procedure. Methods Six cardiac device-related infective endocarditis （CDIE） patients were treated in cardiac surgery department of People＇ s Hospital, Peking University from Feb 1st. 2013 to Feb 1st. 2014. 5 patients were treated by removal of all the infective pacing system and implantation of new permanent epieardial pacemaker in a single procedure. Hybrid technique （ implantation of new epicadial pacemaker from subxiphoid incision combined with transvenous extraction of endocaridal pacing leads ） was used in 3 patients. Traditional surgical technique （open-heart surgery to remove endocardial pacing leads and implant new epieardial pacemaker） was used in 2 patients. Results All 5 cases were survived and cured by this new kind of treatment method. 1 patient treated with hybrid technique previously was converted to open-heart surgery due to residual lead tip and severe tricuspid valve regurgitation. There were no death and recurrence of infection during the follow-up of 1-12 months. All the epicardial pacemakers worked well. Conclusions It is feasible to implant a new epicardial pacemaker and perform epicardial pacing combined with extraction of infected pacing system in a single procedure in treating CDIE patients who are pacing dependent.