心脏置入型电子器械适应证患者合并急性肺血栓栓塞的临床特征初探

Clinical characteristics of patients with indication of cardiac implantable electronic devices implantation complicating with acute pulmonary thromboembolism

目的:分析符合心脏置入型电子器械(CIED)适应证且术前发现急性肺血栓栓塞(APTE)患者的临床特征。方法:该研究为回顾性研究。从2014年1月至2019年5月在中国医学科学院阜外医院就诊且符合CIED适应证的8 641例住院患者中筛选出CIED术前确诊APTE的患者。收集入选患者的临床资料、治疗方案和随访结果。结果:8 641例患者中合并APTE的患者共45例(5‰),将其纳入研究。45例入选患者中男性18例(40%),年龄(73±8)岁,体重指数(27±10)kg/m 2。肺栓塞危险分层,32例(70%)为中危,13例(30%)为低危,无高危患者。38例(84%)患者在明确APTE诊断后启动抗凝治疗。30例(67%)患者完成CIED置入(置入起搏器者27例,心脏再同步化治疗者2例,置入埋藏式心律转复除颤器者1例),其中23例CIED术前开始抗凝的患者术后未发生出血、囊袋血肿等并发症。研究随访(30±7)个月,期间20例患者复查CT肺血管造影示栓塞消溶,2例患者抗凝期间发生出血并发症(脑出血1例,肉眼血尿1例)并停用抗凝药物。15例(33%)行抗凝治疗并暂缓置入CIED的患者中, 2例发生一过性三度房室传导阻滞,住院及抗凝治疗随访期间均未再发生缓慢性心律失常;7例患者再次因症状性心动过缓置入CIED。随访期间5例患者死亡,其中3例为心脏性猝死,1例为APTE并急性脑梗死,1例为肺部感染。 结论:符合CIED适应证的患者中合并APTE者并不罕见,对于此类患者置入CIED同时进行抗凝治疗可能是安全、可行的,需注意APTE患者可发生一过性房室传导阻滞。

Objective To investigate the clinical characteristics of inpatients with the indication of cardiac implantable electronic devices(CIED)therapy and combined acute pulmonary thromboembolism(APTE).Methods We retrospectively screened 8641 inpatients who admitted with the indication of CIED implantation in Fuwai Hospital from January 2014 to May 2019.The clinical characteristics,management strategies and clinical outcome were analyzed for patients diagnosed as APTE.Results APTE were identified in 45(5‰)patients in this cohort,there were 18(40%)male patients,the average age was(73±8)years old and body mass index was(27±10)kg/m2.Thirty-two(70%)patients were at intermediate-risk and 13(30%)at low-risk.Anti-coagulation therapy was initiated in 38(84%)patients,and 30 patients underwent CIED implantation(27 pacemaker,2 CRT and 1 ICD).No postoperative bleeding or pocket hematoma were detected in the 23 patients taking anticoagulation medication before implantation.During an average of(30±7)months′follow up,thrombus was dissolved in 20 patients,hemorrhage complications were observed in 2 patients(1 cerebral hemorrhage and 1 hematuria),anticoagulation therapy was discontinued in these 2 patients.Among 15 patients without immediate CIED implantation and treated with anticoagulation therapy during hospitalization,2 patients developed complete paroxysmalⅢ°atrioventricular block,and recovered after therapy during hospitalization.Seven patients were re-hospitalized for CIED implantation due to bradycardia.Five patients died during follow-up(3 sudden cardiac death,1 APTE combined with cerebral infarction,and 1 pulmonary infection).Conclusion APTE is not rare in patients with the indication of CIED implantation,CIED implantation and anti-coagulation therapy are safe for these patients,and transient atrioventricular block could be detected in APTE patients.