慢性心脏电极穿孔的识别及处理策略分析

Study on the identification and treatment strategy of chronic cardiac perforation caused by pacing lead

目的分析和总结心律植入装置植入术后慢性心脏电极穿孔的的识别以及处理策略。方法对2007年1月至2019年1月于北京大学人民医院诊断慢性心脏电极穿孔并且成功拔除穿孔电极患者的临床资料进行回顾性分析,分析患者临床症状、血流动力学情况、电极拔除情况及并发症等。结果共入选30例,其中胸痛15例(50.0%),呼吸困难4例(13.3%),肌肉刺激3例(10.0%),意识丧失3例(10.0%),无症状者5例(16.7%);合并心包积液2例(6.7%),伴有周围器官损伤1例(3.3%)。30例术前血流动力学均稳定,收缩压(131.5±15.1)mmHg,舒张压(77.0±9.7)mmHg。经静脉拔除19例(63.3%),经开胸手术成功拔除穿孔电极11例(36.7%)。经静脉拔除患者中,直接拔除3例(10.0%),经锁定钢丝拔除12例(43.3%),经Snare下腔回收装置拔除2例(6.7%),经激光鞘拔除1例(3.3%),术前行心包穿刺并留置猪尾导管4例(13.3%)。1例(3.3%)患者经开胸手术拔除穿孔电极术后出现手术切口感染,予抗感染、伤口换药后愈合良好。结论对于血流动力学稳定的慢性心脏电极穿孔,经静脉和手术拔除穿孔电极是有效、安全的处理策略。

Objective To analyze and summarize the identification and treatment strategy of chronic cardiac perforation caused by pacing lead.Methed Retrospectively analyzed the clinical data of patients who were diagnosed with chronic cardiac perforation caused by pacing lead and underwent transvenous lead extraction(TLE)procedure in Peking University People′s Hospital from January 2007 to January 2019.Result The perforating leads of 30 patients with chronic cardiac perforation were successfully removed,including 15(50.0%)patients with chest pain,4(13.3%)patients with dyspnea,3(10.0%)patients with muscle irritation,3(10.0%)patients with loss of consciousness,5(16.7%)patients with no symptoms;2(6.7%)patients with pericardial effusion,and 1(3.3%)patient with peripheral organ injury.The hemodynamics of 30 patients were stable before procedure,with systolic blood pressure of(131.5±15.1)mmHg and diastolic blood pressure of(77.0±9.7)mmHg.The perforating leads were successfully removed in 19(63.3%)patients by TLE,and in 11(36.7%)patients via thoracotomy.Among the patients undergoing TLE,3(10.0%)patients were directly removed,12(43.3%)patients were removed by locking stylet,2(6.7%)patients were removed by Needle′s Eye Snare,1(3.3%)patients was removed by laser sheath,and 4(13.3%)patients underwent pericardiocentesis before procedure.Incision infection occurred in 1(3.3%)patient after thoracotomy,and the wound healed well after anti-infection and dressing change.Conclusion For patients with chronic cardiac perforation who are hemodynamically stable,TLE and via thoracotoray can be safe and effective treatment strategy.