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To abandon or not to abandon: Late consequences of pacing and ICD lead abandonment

机译：放弃或不放弃：起搏和ICD引线遗弃的后期后果

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Abstract Introduction The increasing number of cardiac implantable electronic device complications represents a current problem. Abandoned leads are difficult to manage, even because indications to transvenous lead extraction (TLE) cannot be generalized. The aim of the study was to assess the late consequences of previous abandoned leads. Methods We did a retrospective analysis of clinical data from 3,810 patients undergoing TLE in two high‐volume centers (Poland and Italy) in the years 2006–2017. In order to evaluate the effects of lead abandonment, the patients were divided into a group of 582 (15.3%) subjects with abandoned leads (AL) and a group of 3,228 (84.7%) subjects with functional leads (FL). Results Infective indications to TLE were predominant in the AL group (61.34%?vs 43.4%; P??0.001). AL was associated with a higher number of leads per patient, longer lead dwell times, more frequent venous occlusion, higher probability of intracardiac lead abrasion, and tricuspid regurgitation (P??0.001 for all factors). The presence of AL was connected with more frequent technical complications of TLE (odds ratio [OR] 1.617; confidence interval [CI] 1.412–1.852; P?=?0.000), lower procedural success rate (OR 0.270; CI 0.199–0.363; P?=?0.000), and with higher mortality rate during 3.518 years of follow‐up [hazard ratio 1.286; 95% CI (1.062–1.558), P?=?0.010]. Conclusions Presence of previously abandoned leads was associated with the risk of device infections, technical problems during subsequent lead extraction, dysfunction of tricuspid valve, and worse long‐term outcomes.
机译：摘要引言越来越多的心脏可植入电子设备并发症代表了当前的问题。被遗弃的引线难以管理，即使是对吞气铅提取（TLE）的适应性不能推广。该研究的目的是评估先前被遗弃的引线的后期后果。方法我们在2006 - 2017年历史2006 - 2017年的两年内从两次高批中心（波兰和意大利）中收到了3,810名患者的临床数据进行了回顾性分析。为了评估铅遗弃的效果，将患者分为一组582（15.3％）受试者，其中遗弃的引线（Al）和3,228个（84.7％）受试者，具有功能性铅（FL）。结果在Al组（61.34％Δvs43.4％;p≤x0.001）中，对TLE的感染指示占主导地位。 Al与每位患者的较高铅相关联，较长的铅停留时间，更频繁的静脉闭塞，较高的心内铅磨损，以及三尖瓣反流（P 1 0.001供所有因素的P 1 0.001）。 Al的存在与TLE的更频繁的技术并发症（差距[或] 1.617;置信区间[CI] 1.412-1.852; P？=？0.000），降低程序成功率（或0.270; CI 0.199-0.363; p？=？0.000），在3.518年后续后续的[危险比1.286期间，死亡率较高; 95％CI（1.062-1.558），p？= 0.010]。结论预先废弃的引线的存在与装置感染的风险有关，随后的铅提取，三尖瓣功能障碍术中的技术问题以及更糟糕的长期结果。

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