心律植入装置感染相关静脉闭塞患者的临床特征及电极导线拔除情况分析

Analysis of Clinical Characteristics and Lead Extraction in Patients With Venous Occlusion Related to Infection of Cardiovascular Implantable Electronic Devices

目的:分析心律植入装置感染相关静脉闭塞的发生率及患者的临床特征、电极导线拔除情况,进一步指导电极导线拔除工具的选择。方法:回顾性分析2020年1月至2024年1月于北京大学人民医院因心律植入装置感染行电极导线拔除患者405例,其中男性263例(64.9%),平均年龄为(62.4±13.2)岁。所有患者拔除术前在X线透视下行双侧肘正中静脉造影检查,评价心律植入装置感染相关静脉闭塞情况。按是否发生静脉闭塞分为静脉闭塞组(n=119)和非静脉闭塞组(n=286),分析两组患者的临床特征及电极导线拔除情况。结果:静脉造影检查发现,发生心律植入装置感染相关静脉闭塞患者119例(29.4%),静脉闭塞的最常见部位为锁骨下静脉48例(40.3%),无名静脉闭塞37例(31.1%),腋静脉闭塞30例(25.2%),上腔静脉闭塞4例(3.4%)。静脉闭塞组和非静脉闭塞组患者的年龄、男性比例、植入装置类型、电极导线植入数量、药物治疗的差异均无统计学意义(P均>0.05)。与非静脉闭塞组相比,静脉闭塞组电极导线植入时间较长[(5.9±4.1)年vs.(10.4±3.8)年,P=0.042]。在电极导线拔除方面,与非静脉闭塞组相比,静脉闭塞组患者的拔除手术时间、X线曝光时间均较长(P均<0.05),拔除成功率及并发症的差异均无统计学意义(P均>0.05)。与非静脉闭塞组相比,静脉闭塞组需要更高级电极导线拔除工具(激光鞘、机械扩张鞘、下腔拔除装置)的患者比例更高(67.1%vs.84.0%,P=0.001)。结论:心律植入装置感染相关静脉闭塞发生率为29.4%。静脉闭塞患者电极导线植入时间更长,拔除手术时间、X线曝光时间也更长,且拔除电极导线时多需要更高级的拔除工具。

Objectives:To assess the clinical characteristics and lead extraction in patients with venous occlusion related to infection of cardiovascular implantable electronic devices.Methods:Clinical data of 405 patients(147 men,mean age[62.4±13.2]years)who underwent lead extraction from January 2020 to January 2024 in Peking University People's Hospital were reviewed.Contrast venography of the access vein was retrospectively analyzed.The patients were divided into venous occlusion group(n=119)and non-venous occlusion group(n=286)according to the presence or absence of venous occlusion.The clinical characteristics and lead extraction of patients in two groups were analyzed.Results:Occlusion of the access vein occurred in 119 patients(29.4%).The subclavian vein was occluded in 48 cases(40.3%),brachiocephalic vein was occluded in 37 cases(31.1%),axillary vein was occluded in 30 cases(25.2%),superior vena cava was occluded in 4 cases(3.4%).There were no significant differences between venous occlusion group and nonvenous occlusion group in terms of age,sex,device type,number of leads,or anticoagulation therapy(all P>0.05).Time from implant of the initial leads was significantly longer in the venous occlusion group than in the non-venous occlusion group([10.4±3.8]years vs.[5.9±4.1]years,P=0.042).Clinical extraction success rate and complications were similar between the venous occlusion group and the non-venous occlusion group(both P>0.05).Procedural duration and fluoroscopy exposure time were significantly lower in non-venous occlusion group than in the venous occlusion group(both P<0.05).Patients in the venous occlusion group required more advanced tools(such as laser sheaths,evolution sheaths,and needle's eye snares)for lead extraction compared to patients in the non-venous occlusion group(84.0%vs.67.1%,P=0.001).Conclusions:The incidence of venous occlusion related to infection of cardiovascular implantable electronic devices is 29.4%.Time from implant of the initial leads is significantly longer and lead extraction is more difficult in patients with venous occlusion,and requires more advanced tools and more time to achieve the successful lead extraction.