应用准分子激光鞘技术拔除电极导线的单中心经验

Single Center Experience of Electrode Conductor Removal Using Excimer Laser Sheath Technique

目的:探讨准分子激光鞘拔除电极导线的安全性和有效性。方法:回顾性分析2014年5月至2020年11月于北京大学人民医院应用准分子激光鞘拔除电极导线的157例患者的临床资料。结果:共纳入应用准分子激光鞘拔除电极导线的患者157例,平均年龄(65.28±15.38)岁,其中男性94例(59.87%);共拔除导线288根,其中右心房电极导线102根(35.42%),右心室电极导线112根(38.89%),除颤电极导线59根(20.49%),冠状窦电极导线15根(5.21%);电极导线平均植入时间为(108.79±85.72)个月。157例患者中,电极导线最主要的拔除原因为囊袋感染(81.53%),其次是电极故障(12.74%)、菌血症(2.55%)、感染性心内膜炎(2.55%)、患者自觉不适要求拔除电极(0.64%)。应用准分子激光鞘拔除电极导线的手术成功率为97.45%。7例(4.46%)患者出现心包填塞,其中5例(3.18%)属于严重并发症(急性心包填塞及导线拔除术后需开胸修复瓣膜),包括4例(2.55%)紧急开胸进行心脏修补,1例(0.64%)经心包穿刺置管引流后发现三尖瓣脱垂、三尖瓣重度反流而行外科手术;2例(1.27%)患者术中出现低血压;1例(0.64%)患者于导线拔除术后第14天死亡。结论:准分子激光鞘拔除电极导线具有较高的成功率和安全性。

Objectives:To investigate the safety and efficacy of cardiac lead extraction for heart rhythm implants by excimer laser sheath technique.Methods:Clinical data of patients admitted to Peking University People’s Hospital from May 2014 to November 2020,who were treated with excimer laser sheath to remove electrode leads,were retrospectively analyzed.Results:A total of 157 patients[94 males(59.87%),aged(65.28±15.38)years old]were included in this study.A total of 288 leads were removed,including 102 right atrial electrodes(35.42%),112 right ventricular electrodes(38.89%),59 defibrillation electrodes(20.49%),and 15 coronary sinus electrodes(5.21%).The mean time of implantation was(108.79±85.72)months.The reasons for removal were pouch infection in 128 cases(81.53%),electrode failure in 20 cases(12.74%),bacteremia in 4 cases(2.55%),infective endocarditis in 4 cases(2.55%),and electrode removal in 1 case(0.64%).The success rate of excimer laser sheath technique was 97.45%.Pericardial tamponade occurred in 7 cases(4.46%),of which 5 cases(3.18%)were severe complications,4 cases(2.55%)underwent emergent surgical intervention,1 case(0.64%)received emergent surgical tricuspid valve repair due to severe tricuspid prolapse and insufficiency.Intraoperative hypotension occurred in 2 cases(1.27%).1 case(0.64%)died at 14;day after wire removal.Conclusions:Excimer laser sheath technique is associated with high success rate and safety in the field of cardiac lead extraction.