经静脉拔除114根永久性起搏电极导线

Transvenous Extraction of 114 Permanent Pacemaker Leads

报道经静脉除 114根永久性起搏电极导线的结果。采用血管内反推力牵引技术和标准化器械 ,经上腔和 /或下腔静脉对 75例患者的 114根电极导线进行拔除。拔除指征为起搏系统顽固性感染 (97.3% )和电极导线断裂并脱入心腔 (2 .7% )。结果 :电极导线置入时间 5 .7± 5 .4 (0 .5～ 2 1)年 ,心房和心室电极导线分别为 35根和 78根。完全拔除电极导线 94根 (82 .4 % ) ,部分拔除 15根 (13.1% ) ,其余 5根拔除失败。术中一例因右心耳撕裂发生急性心包压塞。完全或部分拔除电极导线后 ,患者的感染症状被完全控制。结论 :经静脉拔除电极导线具有较高的成功率和安全性 ,是根治起搏器置入术后顽固性感染的有效方法。

This paper reports the result of transvenous extraction 114 permanent pacemaker leads. With the intervascular countertraction technique and standard lead extraction devices, the extraction of 114 pacing leads from 75 patients was attempted via superior and/or inferior vena cava. Indications were refractory infection (97.3%) and migration of broken lead in the heart (2.7%). Results: Leads were implanted 5.7±5.4 (0.5～21) years. Thirty-five and seventy-eight leads were in the atrium and ventricle, respectively. Completed removal was achieved for 94 (82.4%) leads, partial removal for 15 (13.1%) leads, and the rest 5 leads were failure to remove. Cardiac tamponade due to right appendage rupture happened in one case. However, the refractory infection (including septicemia) was controlled after the lead was completely or partially removed. Conclusion: Transvenous lead extraction is the most effective method to treat the refractory infection after pacemaker implantation, with a high success rate and safety.