Chronic transvenous pacemaker lead removal using a unique, sequential transvenous system.
Chronic transvenous pacemaker lead removal using a unique, sequential transvenous system.
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使用独特的顺序经静脉系统去除慢性经静脉起搏器导线。
DOI：
10.1016/0002-9149(90)90934-s
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发表时间：
1990
期刊：
影响因子：
--
通讯作者：
Bruce L. Wilkoff
中科院分区：
文献类型：
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作者：
George K. Brodell;L. Castle;James D. Maloney;Bruce L. Wilkoff
28 名患者成功经静脉移除 43 个连续慢性起搏器导线。对于起搏器连接端子处未通过牵引移除的引线，将独特的锁定管心针推进穿过内线圈管腔并接合在尖端处，以允许牵引而无需引线伸长。未单独用锁定管心针拔出的引线在管心针上保持牵引力，因为护套在引线上前进以扩张和分离粘附于引线的任何纤维组织。通过在起搏器连接端子处施加牵引力，移除了 2 根引线。仅锁定管心针就提取了 9 根导联。锁定管心针和护套都是 32 导联扩张所必需的。有 15 根右心房导线和 22 根右心室导线完全移除。此外，6 个右心室导联被部分完全移除，只留下右心室心尖的尖端。 1 例患者用导线切除撕脱心肌，无后遗症。 1例患者出院18天后出现亚急性血胸需要引流，另一例患者出现锁骨下静脉血栓，经抗凝治疗成功。 1 名患者在新导线最终定位期间出现低血压，该患者对保守治疗有反应。无需开胸手术即可可靠地去除慢性起搏器导线。为了获得一致的成功，需要一种独特的锁定管心针，可以在不延长引线的情况下进行牵引，还需要一个护套来扩张和分离粘附的纤维组织。公认的并发症包括无后遗症的心肌撕脱、亚急性血胸、锁骨下静脉血栓形成和短暂性低血压。
Transvenous removal of 43 consecutive chronic pacemaker leads was successful in 28 patients. For leads not removed by traction at the pacemaker connection terminal, a unique locking stylet was advanced through the inner coil lumen and engaged at the tip to allow traction without lead elongation. Leads not extracted with the locking stylet alone had traction maintained on the stylet as sheaths were advanced over the lead to dilate and detach any fibrous tissue adherent to the lead. By applying traction at the pacemaker connection terminal, 2 leads were removed. The locking stylet alone extracted 9 leads. Both the locking stylet and sheaths were necessary to expiant 32 leads. There were 15 right atrial and 22 right ventricular leads completely removed. Additionally, 6 right ventricular leads were subtotally removed leaving only the tip in the right ventricular apex. Avulsed myocardium was removed with the lead in 1 patient without sequelae. A subacute hemothorax developed in 1 patient 18 days after discharge requiring drainage, and subclavian vein thrombosis developed in another, which was successfully treated with anticoagulation. Hypotension occurred in 1 patient during final positioning of new leads, which responded to conservative treatment. Chronic pacemaker leads can be reliably removed without thoracotomy. Both a unique locking stylet to allow traction without lead elongation and a sheath to dilate and detach adherent fibrous tissue are needed for consistent success. Recognized complications included myocardial avulsion without sequelae, subacute hemothorax, subclavian vein thrombosis and transient hypotension.