Lead Extraction in the Contemporary Setting: The LExICon Study An Observational Retrospective Study of Consecutive Laser Lead Extractions
Lead Extraction in the Contemporary Setting: The LExICon Study An Observational Retrospective Study of Consecutive Laser Lead Extractions
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DOI：
10.1016/j.jacc.2009.08.070
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发表时间：
2010-02-09
影响因子：
24
通讯作者：
Wilkoff, Bruce L.
中科院分区：
文献类型：
--
作者：
Wazni, Oussama;Epstein, Laurence M.;Wilkoff, Bruce L.
目的本研究旨在检查激光辅助电极导线拔除术的安全性和有效性，和风险因素在一个大系列的连续患者。背景的需要，铅提取一直在增加直接关系的数量增加的心血管植入式电子设备。方法结果在2004年1月至2007年12月期间，1,449名连续患者接受了2,405根导线的激光辅助导线拔除术（20至270例手术/部位）。中位植入时间为82.1个月（0.4 - 356.8个月）。电极导线在96.5%的时间内被完全取出，临床成功率为97.7%，实现了与电极导线取出适应症相关的临床目标。当在低容量中心进行时，未能实现临床成功与10年的体重指数相关。20例患者的主要不良事件与手术直接相关（1.4%），包括4例死亡（0.28%）。主要不良反应与体重指数= 2.0的患者相关。全因住院死亡率的指标为囊袋感染、器械相关性心内膜炎、糖尿病和肌酐>= 2.0。结论使用激光鞘拔除电极导线非常成功，手术并发症发生率低。囊袋感染或器械相关性心内膜炎的总死亡率显著增加，特别是在糖尿病、肾功能不全或体重指数的情况下
Objectives This study sought to examine the safety and efficacy of laser-assisted lead extraction and the indications, outcomes, and risk factors in a large series of consecutive patients.Background The need for lead extraction has been increasing in direct relationship to the increased numbers of cardiovascular implantable electronic devices.Methods Consecutive patients undergoing transvenous laser-assisted lead extraction at 13 centers were included.Results Between January 2004 and December 2007, 1,449 consecutive patients underwent laser-assisted lead extraction of 2,405 leads (20 to 270 procedures/site). Median implantation duration was 82.1 months (0.4 to 356.8 months). Leads were completely removed 96.5% of the time, with a 97.7% clinical success rate whereby clinical goals associated with the indication for lead removal were achieved. Failure to achieve clinical success was associated with body mass index 10 years and when performed in low volume centers. Major adverse events in 20 patients were directly related to the procedure (1.4%) including 4 deaths (0.28%). Major adverse effects were associated with patients with a body mass index = 2.0. Indicators of all-cause in-hospital mortality were pocket infections, device-related endocarditis, diabetes, and creatinine >= 2.0.Conclusions Lead extraction employing laser sheaths is highly successful with a low procedural complication rate. Total mortality is substantially increased with pocket infections or device-related endocarditis, particularly in the setting of diabetes, renal insufficiency, or body mass index