血管内牵引法取出起搏电极导管治疗起搏器植入术后…

报告运用血管内牵引法成功取出感染性起搏电极导管２例（起搏电极导管植入时间分别为３年和１６年）。术中采用了不同类型的锁定钢丝。１例患者的电极顶端发生脱落，并游走嵌顿于肝静脉。术后２例患者的感染均得到控制，分别随访２和６个月，患者无不适。     

血管内牵引法取出感染起搏电极导管一例

感染是安置永久起搏器植入术后的常见并发症,一旦出现,常须取出感染的起搏电极导管方可控制感染。以往多采用体外牵引技术或外科手术将电极导管取出,但其并发症多,且成功率较低。近来我院对植入14个月后的感染电极导管在体外牵引失败后的患者,运用锁定钢丝进行血管内牵引法拔除,从而控     

血管内反推力牵引法取出起搏器电极导管治疗起搏器系统感染1例

患者,男,43岁,1988年因病窦综合征行VVI起搏器置入术。1994年、2003年因起搏器电池耗竭更换起搏器,2次手术均经右锁骨下静脉各置入1根电极导管,并发现1988年置入的电极导管断裂,电极一端固定在右心室尖部,一端漂浮在肺动脉内。2005年2月术后因囊袋发生感染,多次行清创术,感染未控制。再经左锁骨下静脉穿刺将起搏器置入左侧胸部新囊袋中,置入电极导管1根,囊袋再次感染、皮肤破溃、起搏器外露。X线片示:左右各有1根电极经锁骨下静脉、上腔静脉至右心室,其中1根电极导管一端在右心室,另一端漂浮在肺动脉。2005年8月采用血管内反推力牵引法行…     

血管内牵引法取出起搏电极导管治疗起搏器植入术后感染（附二例报告）

报告运用血管内牵引法成功取出感染性起搏电极导管２例（起搏电极导管植入时间分别为３年和１６年）。术中采用了不同类型的锁定钢丝。１例患者的电极顶端发生脱落，并游走嵌顿于肝静脉。术后２例患者的感染均得到控制，分别随访２和６个月，患者无不适     

血管内反推力牵引法拔除心内膜起搏电极一例

患者男性、６９岁。因间歇性Ⅲ度房室阻滞（ＡＶＢ）于１９９６年４月２６日经右侧头静脉途径安置了ＶＶＩ起搏器。术后２个月，患者头静脉切口红肿、渗液，给予换药、抗感染治疗无效，炎症播及起搏器囊袋。于１９９６年７月３０日，采用手动直接牵引法试拔电极未成功，随...     

经下腔静脉途径反推力牵引法拔除永久性起搏电极导线

采用经下腔静脉途径 ,对 11例起搏器术后顽固性感染和 2例电极导线断裂患者的电极导线进行血管内反推力牵引拔除术。需拔除电极导线共 17根 (心房和心室电极导线分别为 5和 12根 ) ,其中 15根因起搏器囊袋感染和破溃需拔除的电极导线置入时间为 11.5± 3.5 (8～ 2 0 )年 ,经上腔静脉途径拔除失败。结果 :经下腔静脉途径完全拔除电极导线 15根、不完全拔除 1根、失败 1根 ,无严重并发症。表明对置入年限长久和断裂电极导线 ,经下腔静脉途径的拔除成功率高 ,应作为首选拔除途径     

InSync左心室电极导引导管辅助拔除起搏电极导线一例

对 1例直接体外牵引法和旋转法拔除右心室起搏电极导线失败的患者 ,采用InSync左心室电极导引导管辅助拔除成功。认为起搏电极导线在心肌附着或锁骨下静脉处拔除困难时 ,可尝试用InSync左心室电极导引导管辅助。     

积极开展床旁漂浮电极导管心脏临时起搏术

心血管病的治疗技术中 ,最具有“起死回生”作用的治疗是心脏电复律除颤术和床旁心脏临时起搏术。恶性室性心律失常和极缓慢心律失常 (窦性停搏、病态窦房结综合征和三度房室阻滞 )都能引起血流动力学急剧恶化 ,使病人处于极其危重的濒死状态。此时医生通过娴熟的除颤或床旁起搏技术 ,迅速遏制这些致命性心律失常 ,使病人转危为安 ,生命在短短的几分钟内得到拯救。可以看出 ,心脏电复律除颤术和床旁心脏临时起搏技术对于病人和医生是何等重要。床旁心脏临时起搏技术包括①胸外经起搏电极板心脏起搏 ,这种无创性起搏方法起搏时 ,躯体 (胸部 )…     

经上下腔静脉拔除3根感染性起搏器电极导管1例

患者,女,63岁。反复发作黑朦、晕厥1年,24h长程心电图提示窦性心动过缓、平均心率52次/min、最慢心率30次/min、最长RR间期3.2s,诊断为“病态窦房结综合征”,于1995年行VVI起搏器植入术。2001年因电池耗尽更换为双腔起搏器,原心室电极因阈值不符合要求而弃用。重新经原右侧锁骨     

经静脉拔除114根永久性起搏电极导线

报道经静脉除 114根永久性起搏电极导线的结果。采用血管内反推力牵引技术和标准化器械 ,经上腔和 /或下腔静脉对 75例患者的 114根电极导线进行拔除。拔除指征为起搏系统顽固性感染 (97.3% )和电极导线断裂并脱入心腔 (2 .7% )。结果 :电极导线置入时间 5 .7± 5 .4 (0 .5～ 2 1)年 ,心房和心室电极导线分别为 35根和 78根。完全拔除电极导线 94根 (82 .4 % ) ,部分拔除 15根 (13.1% ) ,其余 5根拔除失败。术中一例因右心耳撕裂发生急性心包压塞。完全或部分拔除电极导线后 ,患者的感染症状被完全控制。结论 :经静脉拔除电极导线具有较高的成功率和安全性 ,是根治起搏器置入术后顽固性感染的有效方法。     

不同类型心房起搏电极的安置经验

报告安置不同类型心房电极５６例的经验。其中螺旋电极２１根（内收式单极１１根、双极８根，暴露式单极２根），倒叉Ｊ形电极３５根。５６例的心房电极均于首次手术时安置成功，住院期间无电极脱位、心肌穿孔及阈值异常增高。随访期有１例患者倒叉电极移位；内收式螺旋单、双极电极和倒叉电极各有１例晚期阈值增高。严格遵守操作规程，将心房电极安置于右心耳并使Ｘ线和心电测试的指标及起搏参数达到可靠的要求，则有助于提高安置心房电极的成功率，并能减少电极移位和阈值升高。     

起搏器更换时原心房心室电极直接参数的分析及意义

目的:分析更换起搏脉冲发生器时电极导线的各项直接参数并评估其意义.方法:76例患者,在起搏器置入术及更换术时,用起搏器分析仪直接测量心室/心房电极参数.其中,VVI起搏器34例,VDD起搏器4例,AAI起搏器4例,DDD起搏器34例,心房电极38例,心室电极72例.至更换脉冲发生器时心室电极在体内埋植时间为97±16(63～158)个月,心房电极在体内埋置时间为88±12(63～125)个月.结果:首次埋置时心房、心室电极起搏阈值分别为0.82±0.21 V、0.58±0.27 V,更换脉冲发生器时心房、心室电极起搏阈为1.37±0.64 V、1.06±0.54 V(P＜0.01),分别是置入时的1.68倍和1.83倍.置入时心房电极阻抗为693.6±125.9(368.4～1022.1)Ω,更换脉冲发生器时为694.4±281.8 Ω(P＞0.05),置入时心室电极阻抗为611.8±194.2 Ω(P＞0.05),更换脉冲发生器时为665.9±227.4(437～1346)Ω(P＞0.05).更换前后心房电极P波与心室电极R波振幅无统计学差异.更换起搏器时,5例心室电极,4例心房电极因起搏阈值大于2.5 V或阻抗小于300 Ω而重新植入电极导线.结论:植入性右心室右心房电极使用7年以上时,大部分的直接参数在正常范围,可以继续使用.     

Percutaneous Extraction of Transvenous Defibrillator Leads Using the VascoExtor Pacing Lead Removal System

In the implantable cardioverter defibrillator era the necessity for lead removal is not negligible. A specially designed extraction lead system for percutaneous removal of such leads is lacking, in contrast to the existing pacing lead extraction systems. We report the successful percutaneous extraction of four implantable cardioverter defibrillator leads in three patients because of lead malfunction using a novel pacemaker lead extraction system, the VascoExtor (VascoMed) system. Three leads were successfully removed in two patients using traction with special locking stylets from the superior approach. One lead was removed using the system's additional extraction tools through the femoral approach. There were no complications. This preliminary experience shows that the VascoExtor (VascoMed) pacemaker lead extraction system can also be used in implantable cardioverter defibrillator lead extraction safely and effectively. In addition to the locking stylets, adjunct percutaneous extraction tools may be needed in some cases.     

Implantable defibrillator lead extraction with optimized standard extraction techniques

Background Implantable cardioverter-defibrillator (ICD) leads might not be extracted especially in developing countries because of the high cost and lack of specialized tools. We aimed to evaluate transvenous extraction of ICD leads using optimized standard techniques. Methods We prospectively analyzed clinical characteristics, optimized extraction techniques and the feasibility of extraction for 40 patients (33 males; mean age 47.9 ? 16.1 years) with 42 ICD leads. Results Complete procedural success rate was 95.2% (40/42), and the clinical success rate was 97.6% (41/42). One ICD lead required cardiothoracic surgery. Minor complications occurred in three cases (7.5%), and no major complications or death occurred. Locking stylets were used to extract most leads (34, 81.0%) and almost half of the leads (20, 47.6%) required mechanical dilatation to free fibrotic adhesions; these leads had been implanted for a longer period of time than the others (43.7 ± 18.2 vs. 18.4 ± 13.4 months, P < 0.05). Three-quarters of the leads (30, 71.4%) were extracted with locking stylets plus manual traction (12, 28.6%), or mechanical dilatation with counter-traction (18, 42.8%) by the superior vena cava approach and one-quarter of the leads (11, 26.2%) were removed by optimized snare techniques using the femoral vein approach. Median extraction time was 20 min (range 2–68 min) per lead. Linear regression analysis showed that the extraction time was significantly correlated with implant duration (r = 0.70, P < 0.001). Median follow-up was 14.5 months (range 1–58 months), no infection, or procedure-related death occurred in our series. Conclusions Our optimized procedure for transvenous extraction of ICD leads provides a practical and low-cost method for standard procedures.