Laser Lead Extractions
Brigham and Women’s Hospital offers a less invasive and more effective option for the extraction of leads -- the wires attached to cardiac pacing devices that follow blood vessels into the heart muscle. The procedure involves the use of an innovative laser device that breaks up scar tissue built up around the leads, so that they can be removed safely and more easily.
Due to the inherent risk and technical challenges of lead extractions (discussed below), most physicians who implant devices are reluctant to perform lead extractions. BWH, which served as a testing site for the laser device before it was approved by the Food and Drug Administration, has become a regional, national, and international referral center for this procedure.
Why do leads need to be removed?
When a decision is made to implant a permanent pacemaker or implantable cardiac defibrillator (ICD), the expectation is that the device will remain in the patient’s body for the rest of his/her life. As with all medical devices, there are certain circumstances that require removal of the permanent system. Such circumstances include infection, inappropriate lead positioning, or lead failure which is often referred to as lead fracture or insulation breach. In addition, as cardiac pacing technology evolves, physicians may wish to upgrade a patient’s existing device with a newer more effective one.
The body’s natural response to a foreign object, such as a pacemaker is to form scar tissue surrounding the leads that course through blood vessels down into the heart. The longer the device remains inside the body, the more scar tissue will adhere to the leads, making removal difficult. Still, if the pacing device must be removed, leads cannot be abandoned, as they would interfere with new devices or cause damage to blood vessels.
What happens during the procedure?
The procedure is performed in an operating room under general anesthesia. Once the patient is prepared for surgery, the physician makes an incision close to the old device, and the generator is removed. The most difficult part of this procedure is not removal of the device, but removal of the leads. The level of difficulty is typically related to the amount of scar tissue that has formed since the device was implanted. If the wires are unable to be removed with gentle pulling, a special laser extraction device is used. This device consists of a sheath wrapped in laser fiberoptics that is advanced through the targeted vein and over the lead. The physician applies a controlled dose of laser energy to break up (ablate) any scar tissue and free the lead that is then pulled out.
Every circumstance is different, so your doctor will let you know if a new pacemaker or defibrillator system will be implanted at that time or after a course of antibiotics. Patients can expect to be in surgery for approximately four hours and are usually admitted to stay one night in the hospital for monitoring and observation if no further treatment is required.
Recovery
After the procedure, patients may experience soreness, swelling and bruising at the site where the device and leads were removed. It takes approximately one week to physically recover from the surgery.
What are the risks associated with this procedure?
Every medical procedure carries risk to your health, but in expert hands, laser lead extraction has about a 95 percent success rate, which is significantly higher than for the conventional procedure, known as percutaneous lead extraction.
Your doctor will discuss with you the risks and benefits of laser lead extraction. In general, this is a low risk procedure, but it does carry a one to two percent chance of life threatening complications. Common risks of this procedure include bleeding, bruising and infection where the incision is made. Less common risks include damage to the blood vessels, damage to the heart muscle, change in heart rhythm, heart attack, stroke, need for urgent cardiac surgery and death.
Click the link below to watch a video on Laser Lead Extractions:
Advancing Cardiac Arrhythmia Care with Implantable Devices and Laser Lead Extractions
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