应用激光鞘拔除电极导线的初步临床经验

Initial experience using excimer laser for the extraction of implanted pacemaker and implantable cardioverter defibrillator leads

目的报道应用激光鞘经静脉电极导线拔除的初步临床经验。方法回顾性分析2015年9月至2017年4月就诊于北京大学人民医院,应用准分子激光鞘拔除电极导线患者的临床资料。结果 35例患者应用激光鞘技术拔除电极导线,年龄(63.4±17.1)岁,其中男性27例(77.1%),共拔除电极导线77根,平均植入年限10(4~26)年,其中除颤电极导线13根(16.9%)。拔除原因分别为囊袋感染25例(71.4%),电极故障5例(14.3%),菌血症3例(8.6%),感染性心内膜炎2例(5.7%)。应用激光鞘电极导线拔除手术完全成功率为97.1%,临床成功率为100%,无一例发生死亡及外科干预的主要并发症。结论准分子激光鞘电极导线拔除起搏及除颤电极导线安全、有效、可提高手术效率。

Objective The present study reports the initial experience using this novel technique to extract implan- ted pacemaker and implantable cardioverter defibrillator （ICD） leads. Methods We performed a retrospective study of consecutive patients undergoing lead extraction using the laser sheath in a single center, from September 2015 to April 2017. Basic clinical data of patients and lead characteristics, indications,and outcomes were analyzed. Results A total of 77 leads, including 13I CD leads, were removed using the laser sheath from 35 patients （age 63.4!17.1 years;27 male, 71.4%）. The median implantation duration was }0 years（range 4-26 years）. Indications were infection （n = 30）, leads fracture （n = 5）.The femoral approach was used in combination with the laser tech- nique in one case. The Evolution sheath was used in combination with the laser technique in one case.Complete pro cedural success was achieved with 34 patients （97.1%）. Although the electrode tip was left behind in the remaining one lead, the desired clinical outcomes could be achieved; which were defined as clinical success. No case resulted in failure. There were no major complications, including death and bleeding requiring open-chest surgery. Conclusions Laser sheaths appear to provide a feasible and effective means of extracting implanted pacemaker and ICD leads.