Re-evaluation of Transvenous Lead Extraction with Modified Standard Technique: A Prospective Study in 229 Patients  

作　　者：褚现明 李学斌 张萍 王龙 李鼎 段江波 李冰 郭继鸿 

机构地区：[1]Department of Cardiology, the Affiliated Hospital of Medical College, Qingdao University [2]Department of Cardiac Electrophysiology, Peking University People's Hospital [3]Department of Biology, Medical College of Qingdao University

出　　处：《Journal of Huazhong University of Science and Technology(Medical Sciences)》2013年第5期650-655,共6页华中科技大学学报（医学英德文版）

基　　金：supported by the National Natural Science Foundation of China(No.81001346);Capital Project(No.Z121107001012016);Shandong Project(No.2012YD18035,2011HZ023);Qingdao Project(No.2012-1-3-5-(4)-nsh,2007WSZD076);Hospital Project(No.47-11)

摘　　要：As new-type powered sheaths are expensive and unavailable, the standard lead extraction techniques remain the mainstay in clinical applications in many countries. The purpose of this study was to re-evaluate the clinical application of the standard lead extraction techniques and equipment, and make some procedural modifications and innovations. In our center, between January 2006 and May 2012, 229 patients （median, 66 years） who underwent lead extraction due to infection and lead malfunc- tion were registered and followed up prospectively with respect to clinical features, reasons for lead ex- traction, technical characteristics, and clinical prognosis. A total of 440 leads had to be extracted trans- venously by using special tools from 229 patients （male, 72.1%）. Vegetations 〉1 cm were detected in six patients. Locking Stylets were applied for 398 （90.5%） leads. Telescoping dilator polypropylene sheaths and counter traction technique were used for 202 （45.9%） leads due to lead adhesion, and the mean im- plant duration of the 202 leads was longer than the other 238 leads （48.9±22.6 vs. 26.6±17.8 months; P 〈0.01）. In addition, modified isolation and snare techniques were used for 56 leads （12.7%）. Minor and major procedure-related complications occurred in three （1.3%） and four （1.7%） cases respectively, in- cluding one death （0.4%）. Severe lead residue occurred in one case. Complete procedural success rate was 96.1% （423/440）, and clinical success rate was 98.9% （435/440）. The median follow-up period was 18 （1-76） months. No infection- and procedure-related death occurred in our series. Our data demon- strated that high clinical success rate of transvenous lead extraction can be guaranteed by making full use of the standard lead extraction techniques and equipment with individualized modifications.As new-type powered sheaths are expensive and unavailable, the standard lead extraction techniques remain the mainstay in clinical applications in many countries. The purpose of this study was to re-evaluate the clinical application of the standard lead extraction techniques and equipment, and make some procedural modifications and innovations. In our center, between January 2006 and May 2012, 229 patients （median, 66 years） who underwent lead extraction due to infection and lead malfunc- tion were registered and followed up prospectively with respect to clinical features, reasons for lead ex- traction, technical characteristics, and clinical prognosis. A total of 440 leads had to be extracted trans- venously by using special tools from 229 patients （male, 72.1%）. Vegetations 〉1 cm were detected in six patients. Locking Stylets were applied for 398 （90.5%） leads. Telescoping dilator polypropylene sheaths and counter traction technique were used for 202 （45.9%） leads due to lead adhesion, and the mean im- plant duration of the 202 leads was longer than the other 238 leads （48.9±22.6 vs. 26.6±17.8 months; P 〈0.01）. In addition, modified isolation and snare techniques were used for 56 leads （12.7%）. Minor and major procedure-related complications occurred in three （1.3%） and four （1.7%） cases respectively, in- cluding one death （0.4%）. Severe lead residue occurred in one case. Complete procedural success rate was 96.1% （423/440）, and clinical success rate was 98.9% （435/440）. The median follow-up period was 18 （1-76） months. No infection- and procedure-related death occurred in our series. Our data demon- strated that high clinical success rate of transvenous lead extraction can be guaranteed by making full use of the standard lead extraction techniques and equipment with individualized modifications.

关 键 词：lead extraction cardiac implantable electrical device INFECTION COMPLICATION 

分 类 号：R541.7[医药卫生—心血管疾病]