非感染患者心血管植入型电子器械升级时导线拔除及再植入的回顾性临床分析  

Retrospective Clinical Analysis on Lead Extraction and Reimplantation Strategies,Success and Complication Rates During Upgrade of Cardiovascular Implantable Electronic Devices in Non-infected Patients

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》2025年第2期170-174,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:分析非感染患者心血管植入型电子器械(CIED)升级时导线拔除及再植入的临床特征。方法:回顾性收集2018年3月至2024年3月期间在北京大学人民医院接受现有CIED[包括心脏起搏器、埋藏式心脏复律除颤器(ICD)、心脏再同步化治疗起搏器(CRT-P)]升级为ICD或CRT-P或心脏再同步化治疗除颤器(CRT-D)或全皮下埋藏式心脏复律除颤器(S-ICD)的66例非感染患者的基线临床资料和手术资料,分析导线拔除和再植入的策略及手术成功率和并发症发生情况。结果:66例患者中,术前造影显示12例(18.2%)患者入路静脉重度狭窄/闭塞,合并导线磨损/穿孔26例(39.4%)。32例(48.5%)患者接受经静脉导线拔除(TLE),其中27例(84.4%)患者拔除所有导线,5例(15.6%)患者仅拔除非功能导线。TLE手术成功率100%,无并发症发生。66例患者中28例(42.4%)患者保留功能性导线同侧植入,22例(33.3%)患者拔除所有导线对侧再植入,5例(7.6%)仅拔除非功能导线同侧再植入,5例(7.6%)拔除所有导线同侧再植入,6例(9.1%)患者弃置导线再植入。升级手术成功率100%,无并发症发生。结论:非感染患者现有CIED(包括心脏起搏器、ICD、CRT-P)升级为ICD或CRT-P或CRT-D或S-ICD时,导线拔除及再植入安全、可行,可同侧或对侧再植入。Objectives:To analyze the clinical characteristics,strategies,success and complication rates of lead extraction and reimplantation during the upgrade of cardiovascular implantable electronic devices(CIED)in non-infectious patients.Methods:This retrospective study collected and analyzed the baseline clinical data and surgical data of 66 non-infected patients who had their existing CIEDs(including cardiac pacemaker,implantable cardioverter defibrillator[ICD],cardiac resynchronization therapy pacemaker[CRT-P])upgraded to ICD or CRT-P or cardiac resynchronization therapy defibrillator(CRT-D)or subcutaneous implantable cardioverter defibrillator(S-ICD)in Peking University People's Hospital from March 2018 to March 2024.We analyzed the strategies of lead extraction and reimplantation as well as the operation success rate and complication rate.Results:Among the 66 patients,preoperative imaging revealed that 12 patients(18.2%)had severe stenosis/occlusion of the venous access route,with lead wear/perforation in 26 patients(39.4%).32 patients(48.5%)underwent transvenous lead extraction(TLE),of which all leads were removed in 27 patients(84.4%),and only non-functional leads were removed in 5 patients(15.6%).The success rate of the TLE procedure was 100%and no complication occurred.Among the 66 patients,functional leads retained and new leads were implanted on the same side in 28 patients(42.4%),all leads were removed and new leads were reimplanted on the opposite side in 22 patients(33.3%),only non-functional leads were removed and new leads were reimplanted on the same side in 5 patients(7.6%),all leads were removed and new leads were reimplanted on the same side in 5 patients(7.6%),and 6 patients(9.1%)had the leads abandoned and then were re-implanled.The success rate of the upgrade surgery was 100%,no complications were reported.Conclusions:When the existing CIEDs(including cardiac pacemaker,ICD,CRT-P)of non-infected patients are upgraded to ICD,CRT-P,CRT-D or S-ICD,lead extraction and reimplantation are safe and feasib

关 键 词：心血管植入型电子器械 升级 导线拔除 导线弃置 再植入 

分 类 号：R54[医药卫生—心血管疾病]