联合上下腔静脉途径心血管植入型电子器械导线拔除回顾性分析

Retrospective analysis of transvenous lead extraction in combined superior approach and inferior approach

目的回顾性分析单中心近年来联合上腔和下腔途径心血管植入型电子器械(CIED)导线拔除术(TLE)的病例特点,探究其与单纯上腔或下腔途径拔除CIED导线病例的不同之处。方法连续入选2011年1月至2018年9月于阜外医院心律失常中心行TLE患者159例。将其依据TLE时血管入路途径分成2组:A组为单纯经上腔或下腔途径拔除组(132例);B组为联合上腔和下腔途径拔除组(27例)。对比2组患者基线资料特点、CIED植入类型、导线拔除情况等。结果与A组相比,B组CIED植入时间更长、既往囊袋清创史和CIED更换史比例更高(P<0.05)。进一步统计学分析示,CIED植入时间对于需行联合上下腔静脉TLE者有独立预测价值;CIED植入时间≥5.25年时,其敏感度和特异度分别为74.1%和67.4%。2组患者共计拔除导线301根:A组拔除249根,B组拔除52根,总体临床成功率为95.2%;其中B组拔除成功率更低(86.7%对97.3%,P=0.002)、严重并发症率更高(18.5%对1.5%,P=0.002)。结论对于CIED植入时间≥5.25年者预示着其需要联合上下腔静脉途径行TLE。对于联合上下腔静脉途径行TLE患者,其成功率较单纯上腔或下腔途径更低,且严重并发症发生率更高。

Objective Report the single center experience of transvenous lead extraction(TLE)via both superior and inferior approach in recent years and focus on the features of combing superior and inferior approach during TLE and the difference between it and single superior approach or inferior approach.Methods One hundred and fifty-nine consecutive patients from Jan.2010 to Aug.2018 who accepted TLE in Fuwai hospital were enrolled in this study.The patients were divided into 2 groups:group A was used imple superior approach or inferior approach(132 cases)and group B was combined superior and inferior approach(27 cases)during TLE.We aimed to compare the patients baseline data,types of cardiovascular implantable electronic device(CIED)and outcomes of lead extraction between two groups.Results Compare to group A,group B had a longer CIED dwell time,higher proportion of pocket debridement history and CIED replacement history(P<0.05).Multivariate analysis showed that CIED dwell time was the independent predictor of group B and the sensitivity and specificity were74.1%and 67.1%respectively when≥5.25 years.A total of 301 leads included 249 in group A and 52 in group B were extracted,the overall clinical success rate was 95.2%.In group B,clinical success rate was lower(86.7%vs.97.3%,P=0.002),and the serious complication rate was higher(18.5%vs.1.5%,P=0.002).Conclusion For CIED patients whose dwell time≥5.25 years it is suggested that they need to perform TLE through combined superior and inferior approach in TLE.This kind of procedures had a lower clinical success rate and higher serious complications rate compare with those use a single approach in TLE.