心腔内电极血栓形成的临床特征及转归

Clinical characteristics and prognosis of endocardial lead thrombosis

目的 探讨心脏植入型电子器械(CIED)术后心腔内电极血栓形成的临床特征、处理及转归。方法 对本院2007~2020年CIED植入术后心腔内电极血栓形成患者的一般资料、主要诊断和合并疾病、CIED植入资料、实验室检查、影像学检查进行临床总结,并分析临床处理方法及转归。结果 共确诊11例,心律失常6例,扩张型心肌病3例,心肌梗死2例。合并心房颤动8例。发生肺动脉栓塞1例。植入VVI、DDDR、ICD、CRT分别为3例、3例、4例和1例。单根电极5例,两根电极4例,多根电极2例。发现血栓形成距离首次植入CIED时间6天至324个月。所有患者行超声心动图检查均发现心腔电极右房段有异常团块附着,其中8例于非常规切面发现。患者确诊后均予抗凝药物治疗,其中5例使用新型口服抗凝药。除了1例患者失访外,其余10例患者在抗凝治疗后4个月内复查超声心动图,均提示血栓消失。结论 心腔内电极血栓形成可发生在CIED植入术后任何时间及血栓风险低危患者,可导致肺栓塞。超声心动图对电极详细追踪检查是诊断及疗效评估的重要手段。

Objective To explore the clinical characteristics and prognosis of endocardial lead thrombosis after cardiac implantable electronic devices(CIED) being implanted. Methods Patients diagnosed with endocardial lead thrombosis after CIED implantation in our hospital from 2007 to 2020 were picked out. We summarized their clinical data, including general information, history, CIED message, laboratory examination and imaging examination, and analyzed their treatment as well as prognosis. Results Eleven patients were figured out. 6 of them were diagnosed with arrhythmia, 3 with dilated cardiomyopathy and the other 2 with myocardial infarction. Among them, 8 cases were suffering atrial fibrillation. Pulmonary embolism occurred in 1 case. There were 3 cases of VVI, 3 cases of DDDR, 4 cases of ICD and 1 case of CRT. There were 5 cases with single lead, 4 cases with double leads and 2 cases with multiple leads. After the first CIED implantation, thrombosis was found 6 days to 324 months later. Abnormal masses were indicated on the leads of right atrial segment in all patients by echocardiography, and particularly 8 cases were detected in the unconventional section. All patients received anticoagulant therapy after diagnosis, and 5 of them received novel oral anticoagulants. Except for 1 patient missing, the thrombosis of the other patients was disappeared in 4 months. Conclusions Endocardial lead thrombosis can occur at any time as well as anyone after CIED implantation, which could provoke pulmonary embolism. Echocardiography is an important means for diagnosis and efficacy evaluation.