New laser treatment eases pacemaker lead replacement

New technology in the Valley offers those with cardiac pacemakers and defibrillators a safer, easier way to have troublesome wire leads removed via laser, rather than the traditional open-chest surgery.

Cardiologist Rohit Sundrani removes a 16-year-old wire lead to an old pacemaker using new laser technology.

Fresno Heart & Surgical Hospital is the only place to offer the laser extraction in a six-county region. Cardiologists Rohit Sundrani and Thampi John said until they began doing the procedure, Valley residents were referred out to Sacramento or Los Angeles for removal of the old flexible wires that delivered electrical impulses to help the heart maintain its rhythm.

The challenge in removing a pacemaker or defibrillator lead from the heart, explained Dr. Sundrani, is that fibrous scar tissue grows around the wire and adheres to it. Before laser technology, when leads malfunctioned or caused localized infections they had to be removed by carefully cutting them out or yanking them out—usually during major surgery that required days of recovery in the hospital. “With the laser, patients usually go home the same day,” said Dr. Sundrani.

Over two-million Americans rely on a pacemaker or defibrillator to regulate the heartbeat. And the risk of infection increases with every pacemaker or defibrillator replacement. Of those patients with defibrillators, as many as 20% can expect a malfunction of the wire that sends electrical signals from a generator into the heart within 10 years of receiving their device.

Dr. Sundrani demonstrated the Spectranetics laser technology recently on an 82-year-old man. “He’s been dependant on a pacemaker for 16 years and when it doesn’t work, his heart can’t function well,” Dr. Sundrani described the case. “In 2004 we replaced the generator and put in a new wire. It looks like he needs a new battery and he’s got an infection in the old wires. We want to take out both wires without opening up his chest. With the laser it’s nice and clean, and we won’t have to open him up.”

When the patient’s lead was replaced in 2004, the old wire was left inside because so much tissue had grown around it and it posed more of a problem to remove, said Dr. Sundrani, adding that this is common.

Dr. Sundrani threaded a catheter along each of the two old pacemaker leads through a small incision in the upper left chest. Then he guided a sheath with a ring of laser energy over the leads to free them from scar tissue that had grown around them, anchoring them to the chest wall. In less than two minutes with short, buzzing bursts of ultraviolet light energy, Dr. Sundrani vaporized the scar tissue and freed the 7-year-old lead.

“Did you see anything on the heart?” Dr. Sundrani called out to the anesthesiologist Oji A. Oji, as he tugged at the lead. “No. Stable.” was the reply, causing smiles all around the operating room.

Dr. Sundrani took another 46 seconds to laser through tissue surrounding the 16-year-old wire and then slipped the lead easily out of the chest.

The laser energy transmitted along flexible fiber-optic strands encased in catheters breaks down the tissue into particles, most of which are smaller than a red blood cell. The tiny particles are easily absorbed by the bloodstream.

James Gardner, 73, of Los Banos, had his pacemaker lead removed and replaced at Fresno Heart & Surgical this past summer after a massive infection. “It was a pretty quick recovery from this,” said his wife Betty Gardner. “We were in and out in a day…We’ve been to Fresno Heart & Surgical Hospital four or five times and we’ve been very happy with it. We had to wait a little longer to schedule this, but we were happy to so we could go to this hospital with Dr. Sundrani.”

After closing up the incision on his 82-year-old patient with four stitches, Dr. Sundrani predicted the Fresno grandfather would be home after a night’s stay in the hospital.

Erin Kennedy reported this story. She can be reached at MedWatchToday@CommunityMedical.org.