Mobile thrombus on cardiac implantable electronic device leads of patients undergoing cardiac ablation: incidence, management, and outcomes.
Mobile thrombus on cardiac implantable electronic device leads of patients undergoing cardiac ablation: incidence, management, and outcomes.
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DOI：
10.1007/s10840-015-0085-2
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发表时间：
2016-08
期刊：
影响因子：
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通讯作者：
Asirvatham SJ
中科院分区：
文献类型：
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作者：
Sugrue A;DeSimone CV;Lenz CJ;Packer DL;Asirvatham SJ
在世界范围内，心血管植入式电子设备（CIED）植入和心脏消融手术的比率正在增加。迄今为止，围消融期CIED导联血栓的处理仍不明确，关键的临床管理问题仍未得到解答。我们试图描述在围手术期检测到CIED铅血栓的患者的临床过程和管理策略。我们对2000-2014年在罗切斯特梅奥诊所接受心脏消融手术的所有患者进行了回顾性分析。如果患者在围消融期影像学检查中记录有CIED导联血栓，则纳入我们的研究队列。我们回顾了电子病历，以确定这些患者的总体管理策略、结果和栓塞并发症。我们的整个队列包括1833例患者，其中27例（1.4%）同时进行了心脏消融手术和CIED导联血栓的影像学检查。27例患者中，男性21例（77%），平均年龄59.2岁。平均随访时间16.5个月（3天- 48.3个月）。抗凝治疗是一种有效的治疗策略，11/14（78.6%）的患者在重新成像时血栓消退或缩小。对于房颤消融，最常见的管理策略是延迟消融并开始/加强抗凝药物治疗。对于室性心动过速消融，大多数手术涉及改良入路，使用逆行主动脉入路进入左心室。没有患者有任何记录的栓塞并发症。在我们的研究队列中，接受消融术的患者中铅血栓的发生率很小（1.4%）。抗凝和延迟消融是房颤消融的成功管理策略。对于接受室性心动过速消融的患者，使用逆行主动脉通道进入心室的改进方法是成功的。在检测到血栓时没有使用华法林抗凝的患者，我们建议开始使用这种药物，目标INR为2-3。对于在检测到血栓时使用华法林的患者，我们建议加强抗凝治疗，目标INR为3.0。
The rates of cardiovascular implantable electronic device (CIED) implantations and cardiac ablation procedures are increasing worldwide. To date, the management of CIED lead thrombi in the periablation period remains undefined and key clinical management questions remained unanswered. We sought to describe the clinical course and management strategies of patients with a CIED lead thrombus detected in the periablative setting. We performed a retrospective analysis of all patients who underwent a cardiac ablation procedure at Mayo Clinic Rochester from 2000-2014. Patients were included in our study cohort if they had documented CIED lead thrombus noted on periablation imaging studies. Electronic medical records were reviewed to determine the overall management strategy, outcomes, and embolic complications in these patients. Our overall cohort included 1833 patients, with 27(1.4%) having both cardiac ablation procedures as well as CIED lead thrombus detected on imaging. Of these 27 patients, 21 were male (77%), and the mean age was 59.2 years. The mean duration of follow-up was 16.5 months (range; 3 days – 48.3 months). Anticoagulation was an effective therapeutic strategy, with 11/14 (78.6%) patients experiencing either resolution of the thrombus or reduction in size on re-imaging. For atrial fibrillation ablation, the most common management strategy was a deferment in ablation with initiation/intensification of anticoagulation medication. For ventricular tachycardia ablations, most procedures involved a modified approach with the use of a retrograde aortic approach to access the left ventricle. No patient had any documented embolic complications. The incidence of lead thrombi in patients undergoing an ablation was small in our study cohort (1.4%). Anticoagulation and deferral of ablation represented successful management strategies for atrial fibrillation ablation. For patients undergoing ventricular tachycardia ablation, a modified approach using retrograde aortic access to the ventricle was successful. In patients who are not on warfarin anticoagulation at the time of thrombus detection, we recommend initiation of this medication, with a goal INR of 2-3. For patients on warfarin at the time of thrombus detection, we recommend an intensification of anticoagulation with a goal INR of 3.0.