心血管植入型电子器械感染经静脉导线拔除后的再评估和再植入策略的临床分析  

Impact of Reassessment and Reimplantation Strategies on Clinical Outcome After Transvenous Lead Extraction of Infectious Cardiovascular Implantable Electronic Devices

作　　者：苑翠珍[1] 昃峰[1] 李鼎[1] 段江波[1] 周旭 吴寸草[1] 何金山[1] 王龙[1] 李学斌[1] YUAN Cuizhen;ZE Feng;LI Ding;DUAN Jiangbo;ZHOU Xu;WU Cuncao;HE Jinshan;WANG Long;LI Xuebin(Department of Cardiology,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院心内科,北京100044

出　　处：《中国循环杂志》2024年第12期1206-1210,共5页Chinese Circulation Journal

基　　金：北京大学人民医院研究与发展基金(RDL2022-19)。

摘　　要：目的:对心血管植入型电子器械(CIED)感染患者经静脉导线拔除(TLE)后个体化再评估和再植入策略进行临床分析。方法:纳入2015年1月至2021年1月于北京大学人民医院因CIED感染行TLE的患者。根据患者的病史、感染类型和心脏检查结果,决定是否再植入以及再植入策略,统计患者再植入率、装置类型、植入部位和并发症情况。结果:本研究共纳入因CIED感染行TLE的患者993例,其中囊袋感染840例(84.6%)。TLE临床成功率为98.3%(976例),围术期死亡率为0.9%(9例)。除围术期死亡病例外,984例患者再评估后,186例(18.9%)无再植入指征,69例(7.0%)拒绝再植入,729例(74.1%)选择再植入。根据患者临床情况制定个体化再植入策略:再植入传统装置703例(71.4%),均植入感染对侧以降低再感染风险;再植入无导线起搏器24例(2.4%),再植入全皮下埋藏式心脏复律除颤器2例(0.2%),主要用于有特定适应证的患者;TLE术中同台再植入率为19.4%(191/984),主要是囊袋感染患者中的心脏起搏器依赖者。CIED升级或降级70例(7.1%)。对984例患者随访(3.9±2.6)年,全因死亡率8.9%(88例),再植入后囊袋感染率1.5%(15例)。结论:TLE后,对CIED感染患者进行个体化再评估能够帮助优化再植入决策,避免不必要的再植入及相关并发症。再植入策略的选择严格基于临床情况。传统装置应优先选择在感染对侧植入,以降低再感染风险;无导线起搏器和全皮下埋藏式心脏复律除颤器适用于特定适应证患者。部分囊袋感染患者在TLE术中同台再植入是可行的,但仍需进一步研究评估其安全性。Objectives:To investigate the impact of reassessment and individualized reimplantation strategies on clinical outcomes in patients with cardiovascular implantable electronic device(CIED)infections following transvenous lead extraction(TLE).Methods:Patients who underwent TLE due to CIED infections at Peking University People’s Hospital from January 2015 to January 2021 were included.Reimplantation decisions,including whether to reimplant and the type and location of the new device,were made based on patient history,infection type,and cardiac examination results.The reimplantation rate,device type,implantation site,and complications were recorded and analyzed.Results:A total of 993 patients were included in this study,of which 840 cases(84.6%)were pocket infections.Among the removed devices,827 cases(83.3%)were pacemakers.The clinical success rate of TLE was 98.3%(976 cases),the perioperative mortality rate was 0.9%(9 cases).Excluding the perioperative death cases,out of 984 survived patients after reassessment,186 patients(18.9%)had no indication for reimplantation,69 patients(7.0%)refused reimplantation,and 729 patients(74.1%)opted for reimplantation.An individualized reimplantation strategy was developed according to their clinical situation.Devices were implanted in 703 patients(71.4%)on the contralateral side to reduce the risk of reinfection;leadless pacemakers(LP)were implanted in 24 patients(2.4%),and subcutaneous implantable cardioverter-defibrillators(S-ICD)were implanted in 2 patients(0.2%),based on specific indications.The rate of simultaneous reimplantation during TLE was 19.4%(191/984),primarily among pacemaker-dependent patients with pocket infections.70 patients(7.1%)underwent device upgrade or downgrade.During a mean of(3.9±2.6)years follow-up,the all-cause mortality rate were 8.9%(88 cases),and the pocket infection rate after reimplantation was 1.5%(15 cases).Conclusions:Individualized reassessment after TLE for CIED infection patients can help optimize reimplantation decision-making and avoid

关 键 词：心血管植入型电子器械 经静脉导线拔除 再植入 感染 

分 类 号：R54[医药卫生—心血管疾病]