Physicians at the International Heart Institute at Loma Linda University Health now perform laser-assisted removal of cardiac leads in patients with a pacemaker or implantable cardioverter defibrillator (ICD), making this advanced treatment more available to patients in the Inland Empire region.

The International Heart Institute uses excimer laser technology as well as mechanical tools to perform the cardiac lead removal procedures. Cardiac leads are the wires that connect pacemaker and ICD devices to the heart muscle through a vein, and the leads may develop problems over time.

Cardiac lead removal is becoming more common as an estimated 700,000 new pacemaker or ICD devices are implanted each year worldwide, and increasingly often when patients are younger in life. ICDs, pacemakers and their associated cardiac leads require lifelong management, and lead removal or replacement is sometimes necessary.

Infections that are not treatable with antibiotics alone can develop around cardiac leads, necessitating their removal, as may malfunction. Lead extraction may also be necessary when a patient’s implantable device is upgraded, requiring additional or different leads to be placed.

Since scar tissue can form around and bind cardiac leads to the heart and blood vessels, the leads cannot always be easily removed. The laser technology emits pulses of ultraviolet light to break up scar tissue, allowing it to be safely absorbed in the bloodstream. Additionally, a significant amount of calcium can build up in this scar tissue, sometimes necessitating mechanical tools to safely, slowly and gently cut through the scar to free the lead.

A high success rate of 97.7 percent makes laser-assisted removal the treatment of choice in many cases. This minimally invasive option offers a safe alternative to lead abandonment, which can create long-term health risks.

At Loma Linda University Health, Electrophysiologist Tahmeed Contractor, MD, performs many of these procedures in collaboration with cardiothoracic surgeons Rosario Floridia, MD, and David Rabkin, MD. In addition to cardiothoracic surgeons and electrophysiologists, the team approach also includes specialists in cardiac anesthesia and infectious disease.  

“I am pleased to offer patients this safe, reliable method of lead management,” Contractor said. “We can now safely address the needs of many patients with implantable pacemakers and defibrillators right here at Loma Linda University Health.”

A high success rate of 97.7 percent makes laser-assisted removal the treatment of choice in many cases.

One of the first patients to undergo the procedure at Loma Linda University Health was 33-year-old Marylou Jimenez, a resident of Yucca Valley in the Mojave Desert. She was diagnosed as a baby with congenital ventricular septal defect, a hole in the wall between the two lower chambers of the heart. At 17 years old, she received her first pacemaker. It was replaced twice over the years.

Jimenez recently switched her care to the International Heart Institute, where she learned that her current pacemaker had reached the end of its useful life. Doctors recommended upgrading to an ICD, which offers extra protection.

“They make you feel comfortable — not like a patient, but like family."Marylou Jimenez

Contractor told her she was a candidate for laser-assisted removal of her old cardiac leads.

“I thought it was interesting,” Jimenez said. “I said, ‘Yes, if I don’t need them.’”

Now about six weeks post-surgery, and feeling her energy return, Jimenez describes her time at Loma Linda University Medical Center with gratefulness.

“Everybody on the staff is really friendly,” she said. “They make you feel comfortable — not like a patient, but like family. I thank the doctors, nurses and staff for making the experience feel safe.”

The expert physicians at the International Heart Institute offer a full complement of adult cardiology, pediatric cardiology, cardiothoracic surgery and vascular surgery services with a whole person care approach. Loma Linda University Medical Center also offers emergency and after-hours care.

Call 800-INTL-HEART or visit ihi.lomalindahealth.org to learn more about the services provided at the International Heart Institute at Loma Linda University Health.