应用激光鞘拔除电极导线的初步临床经验

摘要

Objective The present study reports the initial experience using this novel technique to extract implanted pacemaker and implantable cardioverter defibrillator (ICD) leads.Methods We performed a retrospective study of consecutive patients undergoing lead extraction using the laser sheath in a single center,from September 2015 to April 2017.Basic clinical data of patients and lead characteristics,indications,and outcomes were analyzed.Results A total of 77 leads,including 13I CD leads,were removed using the laser sheath from 35 patients (age 63.4±17.1 years;27 male,71.4％).The median implantation duration was 10 years(range 4-26 years).Indications were infection (n=30),leads fracture (n=5).The femoral approach was used in combination with the laser technique in one case.The Evolution sheath was used in combination with the laser technique in one case.Complete procedural success was achieved with 34 patients (97.1％).Although the electrode tip was left behind in the remainingone lead,the desired clinical outcomes could be achieved;which were defined as clinical success.No case resulted in failure.There were no major complications,including death and bleeding requiring open-chest surgery.Conclusions Laser sheaths appear to provide a feasible and effective means of extracting implanted pacemaker and ICD leads.%目的 报道应用激光鞘经静脉电极导线拔除的初步临床经验.方法 回顾性分析2015年9月至2017年4月就诊于北京大学人民医院,应用准分子激光鞘拔除电极导线患者的临床资料.结果 35例患者应用激光鞘技术拔除电极导线,年龄(63.4±17.1)岁,其中男性27例(77.1％),共拔除电极导线77根,平均植入年限10(4～26)年,其中除颤电极导线13根(16.9％).拔除原因分别为囊袋感染25例(71.4％),电极故障5例(14.3％),菌血症3例(8.6％),感染性心内膜炎2例(5.7％).应用激光鞘电极导线拔除手术完全成功率为97.1％,临床成功率为100％,无一例发生死亡及外科干预的主要并发症.结论 准分子激光鞘电极导线拔除起搏及除颤电极导线安全、有效、可提高手术效率.