Long-term reliability of the defibrillator lead inserted by the extrathoracic subclavian puncture.
Long-term reliability of the defibrillator lead inserted by the extrathoracic subclavian puncture.
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DOI：
10.1002/joa3.12107
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发表时间：
2018-10
影响因子：
2
通讯作者：
Anzai T
中科院分区：
文献类型：
--
作者：
Watanabe M;Yokoshiki H;Mitsuyama H;Mizukami K;Tenma T;Kamada R;Takahashi M;Matsui Y;Anzai T
由于经静脉除颤器电极导线易碎，其故障可能导致危及生命的事件，因此需要可靠的插入技术。虽然胸外穿刺已被引入以避免锁骨下挤压综合征，但关于使用该方法的除颤器电极导线长期存活率的报告，特别是与头部切开术（CD）的比较，仍然很少。我们旨在评价经胸外锁骨下穿刺（ESCP）插入的经静脉除颤器电极导线与CD相比的长期生存率。在1998年至2011年期间，纳入了在北海道大学医院接受植入式心律转复除颤器（ICD）植入的324例连续患者。1998年至2003年通过CD插入ICD电极导线，此后通过造影剂静脉造影引导ESCP插入。电极导线失效定义为非生理性高频率过感知，伴电极导线阻抗异常或感知和起搏阈值高度升高。在324例患者中，37例（11%）使用CD，287例（89%）使用ESCP。中位随访时间为6.2年（IQR：3.2 - 8.3），7根电极导线（CD组2根，ESCP组5根）失效。ESCP组中所有电极导线失效的患者均植入SJM Riata（n = 1）或Medtronic Fidelis电极导线（n = 4）。CD组的5年电极导线生存率为93.8%（CI 95%：77.3 - 98.4%），ESCP组为99.1%（CI 95%：96.6 - 99.8%）（P = 0.903）。单变量考克斯回归分析显示，使用Fidelis或Riata电极导线是ICD电极导线失效的强预测因子（HR 13.8，CI 95%：2.9 - 96.5; P = 0.001）。对比静脉造影引导的胸外穿刺可确保经静脉除颤器电极导线的可靠长期存活。
As the transvenous defibrillator lead is fragile and its failure may cause a life‐threatening event, reliable insertion techniques are required. While the extrathoracic puncture has been introduced to avoid subclavian crush syndrome, the reports on the long‐term defibrillator lead survival using this approach, especially the comparison with the cephalic cutdown (CD), remain scarce. We aimed to evaluate the long‐term survival of the transvenous defibrillator lead inserted by the extrathoracic subclavian puncture (ESCP) compared with CD. Between 1998 and 2011, 324 consecutive patients who underwent an implantable cardioverter‐defibrillator (ICD) implantation in Hokkaido University Hospital were included. ICD leads were inserted by CD from 1998 to 2003 and by contrast venography‐guided ESCP thereafter. Lead failure was defined as a nonphysiologic high‐rate oversensing with abnormal lead impedance or highly elevated sensing and pacing threshold. Of 324 patients, CD was used in 37 (11%) and ESCP in 287 patients (89%). During the median follow‐up of 6.2 years (IQR:3.2‐8.3), 7 leads (2 in CD and 5 leads in ESCP group) failed. All patients with lead failure in ESCP group were implanted with either SJM Riata (n = 1) or Medtronic Fidelis lead (n = 4). Five‐year lead survival was 93.8% (CI95%:77.3‐98.4%) in CD compared with 99.1% (CI95%:96.6‐99.8%) in ESCP group (P = 0.903). Univariate Cox regression analysis showed that the use of Fidelis or Riata lead was the strong predictor of the ICD lead failure (HR 13.8, CI95%:2.9‐96.5; P = 0.001). Contrast venography‐guided extrathoracic puncture ensures the reliable long‐term survival in the transvenous defibrillator leads.