Oct 31 2009
Physicians at St. David's South Austin Hospital are leading the Central Texas region in laser-assisted lead-extractions. Lead-extraction is a complicated procedure to remove leads, or transvenous pacemaker electrodes frequently used in patients with pacemakers or other implanted Cardiac Rhythm Management (CRM) devices.
Recent studies have shown that using a laser can be a safe and effective way to remove cardiac leads when performed by a skilled physician. Previously, lead removal often required "open-heart" surgery.
"Over time, cardiac leads can sometimes fracture, become infected or become less effective due to biological changes at the site where they are implanted in the heart tissue, causing them to malfunction," said Shane Bailey, M.D., an electrophysiologist with Texas Cardiac Arrhythmia Institute at St. David's HealthCare. "This can create a very dangerous situation for the patient."
In many cases, damaged leads can be disconnected and left in the body, and are then replaced with new leads that are positioned to provide better functionality. Eventually, though, nonfunctioning leads must often be removed.
Doctors at St. David's South Austin Hospital are now using a laser device called the Excimer Laser Sheath, which consists of a catheter that follows the lead and uses a laser to free it from the surrounding tissue, which often grows around the lead. A ring of laser energy dissolves binding scar tissue around the circumference of the lead allowing for safe, accurate and efficient cardiac lead removal.
"In the past, leads that were not easily removed had to be extracted using a series of long flexible sheaths," said Robert Canby, M.D., an electrophysiologist with Texas Cardiac Arrhythmia Institute at St. David's HealthCare. "These sheaths were advanced down the target lead, pushing and tearing away the tissue with which the body had coated it. This was a reasonably high-risk procedure that could only have been executed by experienced physicians."
The Excimer Laser Sheath allows physicians to cut away the tissue so that the lead can be removed with minimal trauma. It is especially helpful in dealing with patients who require cardiac lead extraction due to an infection. In such cases, it is unlikely that antibiotics will cure the infection with the leads in place, so they must be removed to provide the body the opportunity to heal.
"Leaving non-functioning leads in the patient's body is no longer an acceptable form of treatment for many patients," Dr. Bailey said. "We now know more about the potential problems and we know that lead removal procedures can be very effective at the hands of an experienced physician."
In addition to using a laser to remove leads, doctors at St. David's South Austin Hospital also remove leads manually or with other mechanical equipment, which account for about half of the lead-removal procedures performed at St. David's South Austin Hospital.
Implantable CRM devices are used to manage cardiac arrhythmia, or an irregular or abnormal heart rate. They are designed to monitor and regulate the heart beat or, in some cases, defibrillate (shock) the heart if it goes into a potentially life-threatening rhythm. CRMs are usually implanted into a patient's upper chest, just under the skin and soft tissue, and can be located on either the left or right side of the chest.
The Excimer Laser is manufactured by Spectranetics Corporation.
Source: http://www.stdavids.com/sdsah.aspx