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UPMC Cardiovascular Institute Cardiologists Using New Laser to Remove Pacemaker/Defibrillator Leads

PITTSBURGH, February 16, 2000 — Cardiologists at University of Pittsburgh Medical Center's Cardiovascular Institute are using an excimer laser to extract old cardiac pacemakers and implantable defibrillator wires from the heart, making it an easier and potentially less dangerous and complicated procedure for patients.

Cardiac pacemakers are battery-operated devices that help the heart beat in a regular rhythm. The implantable defibrillator protects patients at risk from severe heartbeat irregularities called arrhythmias.

One or two wires are threaded into the patient’s heart during implantation of the pacemaker or defibrillator and are used to carry electrical impulses back and forth between the device and the heart. According to the American Heart Association, about 140,000 pacemakers and over 40,000 defibrillators are implanted yearly in the United States.

Sometimes the pacemaker or defibrillator must be replaced because of age, and the wires may require replacement at the same time. Sometimes the wires become infected or can break and must be removed. If the pacemaker has been in place for a long time, the wires may become encased in scar tissue, binding them to the inner lining of the heart and blood vessels and making wire removal very difficult.

The traditional method for removing the wires is to pull on them while pushing against the heart with a surgical brace. The wires also can be removed during open-heart surgery in which the surgeon cuts the wire away, often damaging healthy tissue.

"These procedures can cause complications, including perforation of the lungs or heart and blood vessel damage. There also is a small risk of death. Many times the wires are just left in the heart," said Raul Weiss, M.D., an interventional cardiologist at UPMC Presbyterian and assistant professor of medicine at the University of Pittsburgh School of Medicine. "The excimer laser makes removal much easier and less traumatic for the patient."

The laser is enclosed in a tube and threaded into the heart through an artery in the groin. The tube is slipped over the cardiac wire and slowly advanced to the first area of binding. Controlled bursts of excimer laser energy vaporize the scar tissue. After the scar tissue is cleared, the laser is advanced to the next scar tissue site until the wire is released.

The device is called the Spectranetics Laser Sheath and is approved by the FDA. A recent study found that complete wire removal was successful in 94 percent of cases as compared with just 64 percent using conventional methods.

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