经静脉电极去除术治疗心脏电极穿孔患者的疗效及安全性分析  

Analysis on the efficacy and safety of transvenous lead extraction in the treatment of patients with cardiac lead perforation

作　　者：苑翠珍[1] 乔弘宇 昃峰[1] 吴寸草[1] 段江波[1] 周旭 李学斌[1] Yuan Cuizhen;Qiao Hongyu;Ze Feng;Wu Cuncao;Duan Jiangbo;Zhou Xu;Li Xuebin(Department of Cardiology,Peking University People's Hospital,Beijing 100044,China;Department of Optometry and Ophthalmology,School of Basic Medicine,Shanxi Medical University,Jinzhong 030600,China)

机构地区：[1]北京大学人民医院心内科,北京100044 [2]山西医科大学基础医学院眼视光医学专业,晋中030600

出　　处：《中华医学杂志》2025年第11期839-843,共5页National Medical Journal of China

基　　金：北京大学人民医院研究与发展基金(RDL2022-19)。

摘　　要：探讨经静脉电极去除(TLR)术治疗心脏电极穿孔患者的疗效及安全性。回顾性分析2014年1月至2024年6月在北京大学人民医院因电极穿孔接受TLR术治疗的82例患者病例资料,年龄(68.0±12.6)岁,男38例,女44例。分析电极穿孔患者临床症状、穿孔电极的特征、手术成功率、并发症发生率、TLR术使用工具及随访等情况。80.5%(66/82)患者出现了与电极穿孔相关的临床症状,其中最常见为胸痛[57.3%(47/82)]。穿孔电极中,6.1%(5/82)穿出至心包外,58.5%(48/82)为延迟穿孔,65.9%(54/82)为主动固定电极,78.0%(64/82)穿孔位置为右室心尖部,76.8%(63/82)出现程控电极参数异常。所有电极穿孔的诊断皆借助影像学检查得以确诊。8例高危患者在术前接受了经皮干性心包穿刺。82例患者的TLR手术均获得完全成功,无主要并发症发生。穿孔电极中,57.3%(47/82)徒手去除成功。91.5%(75/82)的患者同台手术中植入了新电极。随访截至2024年8月,共随访(5.1±2.7)年,随访期间7例患者达到终点事件,包括5例死亡和2例再次接受TLR术治疗。在有经验的中心,TLR是心脏植入式电子设备电极穿孔安全有效的处理方式。预防性干性心包穿刺可作为非常规选择。To investigate the efficacy and safety of transvenous lead removal(TLR)in the treatment of patients with cardiac lead perforation.The case data of 82 patients who underwent TLR for lead perforation at Peking University People's Hospital from January 2014 to June 2024 were retrospectively analyzed.The patients'age was(68.0±12.6)years,with 38 males and 44 females.Clinical symptoms of patients with lead perforation,characteristics of the perforated leads,operation success rate,complication incidence,tools used in TLR,and follow-up situation were analyzed.Clinical symptoms related to lead perforation were present in 80.5%(66/82)of patients,with chest pain being the most common[57.3%(47/82)].Among the perforated leads,6.1%(5/82)penetrated outside the pericardium,58.5%(48/82)were delayed perforations,65.9%(54/82)were active fixation leads,78.0%(64/82)of the perforation sites were at the right ventricular apex,and 76.8%(63/82)had abnormal programmed lead parameters.The diagnosis of all lead perforations was confirmed by imaging examinations.Eight high-risk patients received percutaneous dry pericardiocentesis before surgery.Eighty-two patients underwent TRL surgery successfully,and no major complications occurred.Among the perforated leads,57.3%(47/82)of the perforated leads were successfully removed manually.New leads were implanted in 91.5%(75/82)of patients during the same operation.Follow-up was conducted until August 2024,with a total follow-up duration of(5.1±2.7)years.During the follow-up period,a total of 7 patients reached the end events,including 5 deaths and 2 patients who underwent TLR again.In experienced centers,TLR is a safe and effective treatment approach for cardiac implantable electronic devices lead perforation.Prophylactic dry pericardiocentesis can be used as an unconventional option.

关 键 词：电极 植入 电极穿孔 心包穿刺 心包积液 经静脉电极去除 

分 类 号：R47[医药卫生—护理学]