Ischémique! 38 ,
pulmonaire"(avant"extraction ,
ET)"en"mois"(extrêmes)" 61!±!59, p.5 ,
indication"remise"en"cause"(42"cas),"indication"initiale" Maladie!rythmique!atriale, p.5 ,
!dans!leur! intégralité,!sans!complication!majeure!lors!de!la!procédure)!est!de!82, p.1 ,
procédural"ou"succès"clinique"(par"procédure ,
radiologique"complet"ou"partiel"(par"sonde) ,
3!complications!majeures!per!procédure!(1,2%)!dont!deux!décès!per!procédure ,
!après!limitation!de!soins!en!réanimation,!sont!donc!imputables!aux!241! procédures!d'extractions.!Ces!trois!patients!avaient!pour!indication!d'extraction!une! endocardite!infectieuse!sur!sonde ,
implantation!(mois)! 111 ,
Facteurs de risque de complication majeure per procédure ou à 30 jours ,
implantation!(mois)! 56 ,
!on!se!heurte!à!la! différence!dans!la!définition!du!succès.!En!effet,!les!études!publiées!avant!2009!ne!décrivent! pas!systématiquement!le!taux!de!succès!procédural!(retrait!de!l'intégralité!des!sondes! ciblées!lors!de!la!procédure),!puisque!cette!définition!a!été!introduite!en!2009,!suite!aux! recommandations!de!l'HRS!(Heart!Rythm!Society)(13).!Auparavant ,
!lors!de!66!procédures!concernant!140!sondes.!L'âge! moyen!des!sondes!était!de!85!mois.!L'indication!principale!étant!l'infection!(au!sens!large!du! terme!:!infection!de!poche,!endocardite!sur!sonde,!menace!d'extériorisation!de!boitier, !:! Evolution!Medical!Dilator!Sheath?!(Cook!Medical!©).!!, 2009. ,
!L'âge!moyen!des!sondes!à!l'extraction!est!légèrement!supérieur! au!nôtre!dans!les!études!citées!ciTdessus!(de!84!à!94!mois!contre!61!mois!dans!notre!étude).! Or!on!sait!que!le!taux!d'échec!augmente!en!même!temps!que!l'âge!d'implantation!des! sondes.!Ces!résultats!peuvent!être!expliqués!par!l'utilisation!de!gaines!motorisées!(Laser!ou! Evolution)!dans!100% ,
implantation!des!sondes! 61! 85! 94! 84! Indication!principale!d'extraction! Infection, 51%)! Infection!(59%)! Infection!(50%)! Infection!(100%)! ,
!qui!recense!183! extractions!concernant!369!sondes.!L'âge!moyen!des!sondes!à!l'extraction!était!de!75!mois.! L'indication!principale!d'extraction!était!de!nature!infectieuse!(77%).!Le!Laser!était!utilisé! dans!44%!des!cas, 2007. ,
!sur!la!période!de!!pour!300! procédures!et!518!sondes.!L'âge!moyen!des!sondes!à!l'extraction!était!de!86!mois,! l'indication!principale!était!l'infection!(74%)!et!les!gaines!motorisées!n'étaient!pas!utilisées! dans!cette!étude.!Par!contre, 2002. ,
sondes,!avec!une!durée!moyenne!d'implantation!des!sondes!de!70!mois.! L'indication!principale!d'extraction!était!l'infection!(59%) ,
!pour!1193! procédures!et!2062!sondes,!avec!une!durée!moyenne!d'implantation!des!sondes!extraites!de! 69!mois.!L'indication!principale!d'extraction,!comme!pour!les!études!précédentes,!était! l'infection!(84%!des!procédures).!Les!gaines!motorisées!n'étaient!pas!utilisées, 2007. ,
! concernant!498!procédures!et!975!sondes.!L'âge!moyen!des!sondes!était!de!90!mois, 2007. ,
!!L'âge!moyen!des! sondes!est!comparable!ou!plus!élevé,!la!principale!indication!d'extraction!similaire! (indication!de!nature!infectieuse)!Ce!qui!diffère,!ce!sont!les!outils!et!les!techniques!utilisées ,
!seule!la!durée!d'implantation!était!liée!de!façon! statistiquement!significative!(P=0,029)!avec!un!succès!radiologique!complet!ou!partiel!(Odds! Ratio!par!année!0,88) ,
!(70)!ont!montré!qu'en!analyse! multivariée,!seule!l'âge!de!la!sonde!lors!de!l'extraction!était!un!prédicteur!d'échec ,
!l'âge!à!l'implantation!est!un!facteur!prédictif!d'échec!en! analyse!univariée,!ce!critère!n'est!pas!retrouvé!!en!analyse!multivariée ,
!Les!disparités! observées!entre!les!études!doivent!tenir!compte!du!volume!du!centre!et!de!l'expérience!de! l'opérateur,!mais!également!de!la!population!concernée.!En!effet, 6%!(Gaca!et!coll ,
!l'endocardite!sur!sonde! (p=0,009),!la!présence!de!végétations!en!ETT!(p=0,003)!et!en!ETO!(p=0,011), p.5 ,
!(77)!ont!trouvé!comme!seul!facteur!de!risque!de! complications,!en!analyse!multivariée,!l'utilisation!du!Laser!de!façon!bilatérale!lors!de!la! même!procédure.!Wazni!et!coll ,
4%!(69/241!procédures)! L'indication!initiale!a!ainsi!été!!remise!en!cause!chez!42!patients!(17,4%)!tandis!que!chez!14! patients!(5,8%),!le!risque!de!réimplantation!a!été!jugé!supérieur!au!bénéfice!potentiel!de!la! réimplantation.!Il!s'agissait!quasi!exclusivement!de!pacemaker ,
!alors!que!toutes!les!indications!d'extraction!étaient!de! nature!infectieuse,!chez!les!72!patients!dont!on!connaissait!l'indication!d'implantation! initiale!(pacemakers!exclusivement),!30!patients!n'avaient!pas!été!réimplantés!(42%) ,
!(86)!et!ceux!de!notre!étude!soulèvent!des!interrogations! quant!à!l'indication!initiale!d'implantation ,
9%!(7!patients)!Ce!taux,!qui!est!plus!lié!au!patient!et!à!l'indication!d'extraction!qu'à! l'extraction!en!elleTmême,!n'est!pas!systématiquement!rapporté!dans!la!littérature ,
!à!la!survenue!de!complication!majeure!per!procédure!et!à!30!jours.! " Nos!résultats!sont,!pour!des!indications!comparables,!pour!un!volume!plus!faible ,
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