摘要
目的探讨同期进行起搏系统感染移除及无导线起搏器植入术的可行性和安全性。方法本研究为单中心回顾性病例系列分析,连续纳入2021年9月至2022年8月在中山大学孙逸仙纪念医院行感染起搏系统移除并同期植入无导线起搏器的患者,并分别在术后1、3、6个月进行常规随访,监测无导线起搏器电学参数、C反应蛋白、白细胞计数,超声心动图检查有无赘生物等。结果纳入同期手术患者5例,均为男性,年龄(74.80±15.83)岁,3例为单纯囊袋感染,2例为囊袋感染合并血行感染。手术策略顺序:4例先行临时起搏,再行感染起搏系统完全移除,最后行无导线起搏器植入术;1例患者先行无导线起搏器植入术,再行感染起搏系统完全移除。5例患者术前复查血培养均为阴性,无血行感染及感染性心内膜炎相关表现,均成功完全拔除所有导线,术中导线头尾端培养、术后血培养均为阴性。5例患者均成功植入无导线起搏器,从右股静脉穿刺至移除递送系统时间为(41.20±11.36)min。其中1例心室导线拔除后三尖瓣反流加重,余未见其他手术并发症。随访(6.00±3.79)个月,无导线起搏器电学参数稳定。随访中,无再发感染征象,无新发心力衰竭、起搏器综合征和死亡。结论针对部分起搏系统感染患者(无导线感染、无感染性心内膜炎且术前血培养阴性),感染起搏装置完全移除并同期植入无导线起搏器可能是安全、可行的,后续需更大样本量和更长随访时间的研究进一步评估。
Objective To investigate the feasibility and safety of concomitant leadless pacemaker implantation and lead extraction for cardiac implanted electronic device infection.Methods The study was designed as a single center retrospective case series analysis.From September 2021 to August 2022,patients who had a leadless pacemaker implanted before,or on the same day as lead extraction procedure for device infection at Sun Yat-sen Memorial Hospital of Sun Yat-sen University were included in the study.Routine follow-up was carried out 1 month,3 months and 6 months after the operation to evaluate the electrical parameters,blood cell analysis and echocardiography.Results Totally 5 patients were included.All were male,with an average age of(74.80±15.83)years.Three cases were isolated pocket infection,and the other 2 cases were isolated pocket infection combined with systemic infection.In 4 cases,temporary pacing was performed first,then the infected pacing system was completely removed,and finally the leadless pacemaker implantation was performed.One patient underwent leadless pacemaker implantation first,and then the infected pacemaker system was completely removed.All electrodes were successfully removed in 5 patients.The blood culture before and after operation,and the tip culture of electrodes were negative,and there were no signs of systemic infection or infective endocarditis.Ledless pacemaker implantation was successful in all 5 cases.And the average procedure time was(41.20±11.36)minutes.The tricuspid regurgitation aggravated in one patient after the ventricular electrode was removed.And no other surgical complications were found in the other patients.The average follow-up time was(6.00±3.79)months,and the electrical parameters of leadless pacemakers remained stable.There were no signs of recurrent infection,new onset heart failure,pacemaker syndrome and death.Conclusion For patients with certain type of pacemaker system infection(no lead infection,no infective endocarditis and negative blood culture before operation),implantation of leadless pacemaker before or on the same day as removal of the infected pacemaker device may be safe and feasible.
作者
麦憬霆
陈样新
谭冬蕊
郑韶欣
郑钰萍
袁沃亮
王景峰
周淑娴
Mai Jingting;Chen Yangxin;Tan Dongrui;Zheng Shaoxin;Zheng Yuping;Yuan Woliang;Wang Jingfeng;Zhou Shuxian(Department of Cardiology,The Sun Yat-sen Memorial Hospital of Sun Yat-sen University,Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology,Guangzhou 510120,China)
出处
《中华心律失常学杂志》
2022年第6期506-510,共5页
Chinese Journal of Cardiac Arrhythmias
基金
国家自然科学基金(81870294)。
关键词
心脏起搏器
人工
起搏系统感染
无导线起搏器
导线拔除
Pacemaker,artificial
Cardiac implanted electronic device infection
Leadless pacing
Extraction
