经静脉途径拔除心脏植入型电子装置电极导线的回顾性分析

A retrospective analysis of transvenous leads extraction of cardiac implantable electronic devices

目的 分析经静脉拔除(TLE)心脏植入型电子装置(CIED)电极导线结果并筛选出并发症的危险因素。方法 回顾性分析2016年1月至2021年12月就诊于新疆医科大学第一附属医院,因各种原因行TLE患者的临床资料。通过向前逐步logistics回归分析筛选出并发症的危险因素。结果 经TLE术的69例患者中,年龄65(58,75.5)岁,女性占44.9%。其中囊袋感染20例,参数异常或者升级CIED装置18例,电极相关并发症31例,总共拔除94根导线,导线植入年限为19.00(5.0,95.50)个月,最长植入时长314个月。电极完全拔除成功率为97.1%,临床拔除成功率为100%。6例患者拔除中出现并发症,总体并发症发生率8.7%,严重并发症发生率为1.4%。单因素和多因素logistics回归分析显示初始电极植入时间≥10年会增加TLE术并发症发生风险(OR=9.054,95%CI 1.214~67.518,P=0.032)。结论 TLE是处理CIED电极相关并发症主要的手段,安全性及有效性较高。CIED初始电极植入时间≥10年会增加TLE并发症发生风险。

Objective To analyze the results of transvenous lead etraction(TLE)cardiac implantable electronic devices(CIED)electrode leads and to screen for risk factors for complications.Method Retrospective analysis of clinical data of patients who attended the First Affiliated Hospital of Xinjiang Medical University from January 2016 to December 2021and underwent TLE for various reasons.The binary logistic regression analysis method was used to analyze the two groups of variables by single-factor logistic regression analysis.Then,the variables with P-value less than 0.2and the variables confirmed by literature research were included in the multivariate logistic regression analysis,and the forward stepwise regression method was selected to screen the risk factors.Results Of the 69 patients who underwent transvenous lead removal,the mean age was 65(58,75.5)years and 44.9%were female.There were 20cases of capsular bag infection,18cases of abnormal parameters or updated CIED devices,and 31ca-ses of lead-related complications.A total of 94leads were removed,with a mean lead implantation duration of 19.00(5.0,95.50)months and a maximum implantation duration of 314months.The success rate of complete lead extrac-tion was 97.1%and the clinical extraction success rate was 100%.Six patients had complications during extraction,with an overall complication rate of 8.7%and a serious complication rate of 1.4%.Univariate and multifactorial lo-gistic regression analysis showed that initial lead implantation time≥10years increased the risk of complications in TLE surgery(OR=9.054,95%CI 1.214-67.518,P=0.032).Conclusion Transvenous lead extraction is current-ly the primary means of managing CIED lead-related complications with high safety and efficacy.The risk of TLE procedure complications is increased when the initial CIED lead implantation time is≥10years.