单中心经静脉拔除心脏植入式电子装置电极导线的回顾性分析  

Retrospective analysis of single-center transvenous removal of cardiac implantable electronic device electrode leads

作　　者：王建华 孙璐 徐健[1] 李述峰[1] 曹威[1] WANG Jian-hua;SUN Lu;XU Jian;LI Shu-feng;CAO Wei(Department of Cardiology,Second Affi liated Hospital of Harbin Medical University,Harbin 150086,China)

机构地区：[1]哈尔滨医科大学附属第二医院心内科,黑龙江哈尔滨150086

出　　处：《中国介入心脏病学杂志》2023年第5期328-332,共5页Chinese Journal of Interventional Cardiology

摘　　要：目的探讨心脏植入式电子装置(CIED)电极导线粘连及经静脉路径拔除的影响因素。方法回顾性分析2018年1月至2021年8月于哈尔滨医科大学附属第二医院行CIED电极导线拔除术的患者,分析总结影响导线粘连及拔除的相关因素。结果共入选36例患者,4例(11.1%)植入单腔起搏器、23例(63.9%)植入双腔起搏器、7例(19.4%)植入心脏再同步起搏器及2例(5.6%)植入心脏再同步除颤器。共拔除电极导线46根,植入时间为(91.95±48.71)个月,电极拔除成功率为87.0%(完全成功37根,临床成功3根),其中徒手拔除27根(58.7%),锁定钢丝锁定后拔除10根(21.7%),使用机械切割鞘管拔除7根(15.2%),经下腔回收装置拔除2根(4.3%)。住院期间次要并发症发生率为2.8%(1例患者拔除时出现心脏穿孔)。电极导线与心肌组织或静脉系统粘连组14例,未与心肌组织或静脉系统粘连组22例,两组电极导线的植入时间差异有统计学意义(P=0.040)。成功拔除电极导线组40根,失败组6根,两组是否与心肌/静脉系统粘连差异有统计学意义(P=0.028)。结合临床因素进一步将有意义的变量纳入二元Logistic回归分析显示,植入时间是电极导线发生粘连的危险因素(OR 1.05,95%CI 1.02~1.08,P=0.004),而粘连的导线则极大增加了拔除失败的风险(OR 10.36,95%CI 1.09~98.19,P=0.041)。受试者工作特征曲线分析显示,植入时间可独立预测电极导线粘连且效能较高,曲线下面积为0.84(95%CI 0.73~0.95,P<0.01),截断值>78个月,敏感度为0.94,特异度为0.61。结论随着电极导线植入时间的延长,导线粘连发生的概率增高,植入时间>78个月的电极导线更容易发生粘连。Objective To explore the infl uencing factors of electrode lead adhesion and venous extraction of cardiac implantable electronic devices(CIED).Methods The patients who underwent electrode wire extraction of cardiac implantable electronic devices in the second affiliated Hospital of Harbin Medical University from January 2018 to August 2021 were analyzed retrospectively,and the related factors aff ecting wire adhesion and removal were analyzed and summarized.Results A total of 36 patients were enrolled,4(11.1%)with single-chamber pacemakers,23(63.9%)with dual-chamber pacemakers,7(19.4%)with CRT-P and 2(5.6%)with CRT-D.A total of 46 electrode leads were removed and the implantation time was(91.95±48.71)months,with a successful electrode removal rate of 87.0%(37 complete and 3 clinical successes).Of these,27(58.7%)were removed manually,10(21.7%)were removed after locking with lead locking device,7(15.2%)were removed with 5evolution mechanical sheath and 2(4.3%)were removed with an inferior cavity assist device(Snare)extraction.The incidence of peri-operative complications during hospitalization was 2.8%(1 patient had cardiac perforation during extraction).14 patients(38.9%)developed adhesion between the electrode and myocardial or venous tissue.There was no signifi cant diff erence in basic diseases such as age,sex,hypertension,diabetes and test indexes such as low density lipoprotein,plasma fibrinogen and the number of implanted electrodes between the two groups(P>0.05).There was signifi cant diff erence in implantation time(P<0.05).Both univariate analysis and regression models suggest that the success rate of removing the electrode lead was not related to the electrode position,implantation time,infection of the pacemaker system,removal tool or extraction route,but related to the adhesion of the electrode lead.Conclusions With the extension of the implantation time of the electrode wire,the probability of wire adhesion increased,and electrode wires with implantation time greater than 78 months are more prone to

关 键 词：心血管病学 电极导线拔除 电极导线粘连 心脏植入式电子装置 

分 类 号：R543[医药卫生—心血管疾病]