By Dr. Cyrus Kocherla
McLeod Electrophysiology Services
Implantable devices, which include pacemakers and implantable cardioverter defibrillators, are small generators that are placed under the skin in the left or right upper chest area. They are attached to small wires called leads that carry current back to the heart.
When a permanent pacemaker or implantable cardioverter defibrillator is implanted, the expectation is that the device will remain in the patient’s body for the rest of their life. But, as with all medical devices, there are circumstances that may require the removal of the system.
The body’s natural response to a foreign object, such as a pacemaker, is to form scar tissue surrounding the leads that run through the blood vessels down to the heart. The longer the device is inside the body, the more scar tissue there will be, making removal difficult. Old leads cannot remain in the body as they would interfere with new devices. If the physician is unable to remove the lead with gentle pulling, a special laser extraction device is used.
With the extraction device, a controlled dose of laser energy is applied to break up the scar tissue and free the lead so it can be pulled out.
The laser energy produces pulsed bursts of UV light energy that gently dissolve the fibrous tissue into tiny, microscopic particles which are easily absorbed into the bloodstream.
Sometimes new leads will be implanted during the extraction procedure. It depends on the reason for the lead removal. It is essential any infections be cleared before implanting new leads.
Because of the complex technical requirements, lead extraction should only be performed in specialized centers. Studies have shown that the procedure is more likely to be successful when performed by physicians and medical centers, such as McLeod Regional Medical Center, which have the experience and training in caring for patients in need of lead extractions. The McLeod Heart & Vascular Institute team has been a pioneer in developing a program that safely and effectively removes leads for patients in our region.
An electrophysiologist is a physician who specializes in evaluating the abnormalities of the heart’s rhythm. Dr. Cyrus Kocherla is one of three physicians at McLeod whose specialty is in the electrical system of the heart or electrophysiology, a study of the electrical impulses of the heart. Dr. Kocherla is accepting new patients. Appointments with Dr. Kocherla at McLeod Cardiology Associates can be made by calling 843-667-1891.