When a pacemaker or implantable cardioverter defibrillator (ICD) is implanted in the chest to treat patients with irregular heartbeats, leads run from the device through veins to the heart’s chambers allowing rhythm monitoring and the ability to deliver energy should the heart get out of rhythm.
Should a device need to be removed for reasons like updating or infection, new leads need to be inserted as veins only have so much capacity. Replacing them is challenging and many physicians who implant devices prefer not to remove them due to inherent risks. Scar tissue builds up around the leads and become strongly adhered to the body’s vessels. Historically, physicians would simply pull leads from the arteries and risks included leaving broken lead fragments behind or damaging vital body structures.
Now, in a procedure called laser lead extraction, surgeons and electrophysiologists at the Center for Comprehensive Cardiovascular Care (the C4) at Saint Louis University Hospital partner to insert a sheath wrapped in laser fiberoptics through the targeted vein and over the lead. Laser energy breaks up the scar tissue and frees the lead that is then pulled out.
“This is a much less-invasive and safer alternative than previous methods,” says Richard Lee, MD, cardiac surgeon, co-director of the center and a SLUCare physician. “Much research exists suggesting cardiac surgeons should be the ones removing the leads and here we are able to do that in tandem with an electrophysiologst.
“The message from the Heart Rhythm Society guidelines are clear: the best outcomes require a strong collaboration between surgery and cardiac electrophysiology, just like the one we have at the C4,” says Dr. Lee, who primarily performs the procedure with Saint Louis University Hospital electrophysiology chief Ali Mehdirad, MD.
Patients are put under anesthesia for the surgical procedure and usually have a one evening hospital stay. According to 2011 study published in the journal Circulation, national success rates with laser lead extraction exceed 90 percent.
For more about the Center for Comprehensive Cardiovascular Care (the C4) at Saint Louis University Hospital, visit heart.sluhospital.com.
About Saint Louis University Hospital Saint Louis University Hospital is a 356-licensed bed quaternary/tertiary referral center located in the heart of the city of St. Louis. Approximately 75 percent of patients are drawn from a 150-mile radius. Through affiliation as the teaching hospital for Saint Louis University, the hospital provides patients and their families with an environment of medical innovation. Working in this endeavor are the hospital’s medical staff partners, SLUCare, the physicians of Saint Louis University. The hospital admits more than 17,000 patients annually, performs more than 200 organ transplants a year and is a Level I Trauma Center that treats more than 2,000 major trauma cases a year. For more information, please visit www.sluhospital.com.
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