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Release Date: 8/6/2009
Electrophysiologist Performs Laser-Assisted Removal of Heart Pacemaker, Defibrillator Leads
Rajiv Handa, M.D., is a cardiac electrophysiologist who performs laser-assisted lead extractions at St. Anthony’s Medical Center.
More than two million Americans rely on implanted pacemakers or defibrillators to regulate rhythm of their heart beats. The electronic device is surgically implanted near the patient’s left shoulder, with lead wires extending through a vein into the heart.
Over time, leads may fail, requiring new leads to be threaded through the same vein, alongside the failed ones. Eventually, this can cause congestion from too much hardware in the vein, leading to vein blockage. It also can cause inappropriate shocking by the defibrillator because of one lead rubbing against the other and making noise. And, if a lead gets too close to bone, it can be crushed. But the most serious risk is infection.
Michael Gimlin, 50, had a triple bypass and valve repair surgery after his heart attack three-and-a-half years ago. He also had a pacemaker surgically implanted. Then his problems began.
“The leads kept breaking and had to be replaced,” Gimlin said. “Then, about five months ago, I woke up to my pacemaker alarm. I thought I was going to get shocked, and it was pretty frightening. It was another broken lead; so the cardiac surgeon opened my chest again – probably for the fourth time – and decided to replace the pacemaker as well.”
Three weeks later, Gimlin’s chest was red and inflamed. It was infected, and everything had to come out. His cardiologist advised him to see Rajiv Handa, M.D., a cardiac electrophysiologist who performs laser-assisted lead extractions at St. Anthony’s Medical Center.
Dr. Handa received training in the specialized laser technique through a two-year fellowship at Hahnemann Hospital in Philadelphia, the fourth largest extraction hospital in the country. He only performs the procedure at St. Anthony’s, since the medical center acquired the latest laser equipment last year.
“Leads that have been in place for seven to 10 years (the expected life of the battery powering the device) may be surrounded by extensive scar tissue,” Dr. Handa said. “But even leads in place for as little as three months already may be imbedded in scar tissue. It is a tedious, risky procedure, and there is a shortage of people trained to perform it.”
To remove a lead, Dr. Handa opens the pocket containing the electronic device, frees up the lead and inserts a locking device into it. He then places a laser extraction sheath over the lead, energizes the sheath with laser energy and starts the extraction process.
“Laser energy is powerful, easily cutting through fibrous tissue,” Dr. Handa said. “Before, with manual sheaths, it took 20 to 40 minutes to remove each lead; it now takes me three to 10 minutes to remove a lead. The approach is old, the technique is new; and the rate of major complications (like excessive bleeding or a rupture of the heart muscle) is less than 0.5 percent.”
Gimlin experienced no complications when Dr. Handa removed his infected device and leads, managed the infection so the wound healed from the inside out, then, three months later, implanted a new pacemaker.
“That was about a month ago, and I’m back to working full time, feeling better than I have in quite some time,” Gimlin said. “I was so impressed with Dr. Handa’s professionalism. We had a meeting before the surgery, and he showed my wife and me all of the pacemakers available. I asked what he recommended, and he selected one and explained why. He’s really such a nice, warm and gentle man – and a brilliant physician.”
Gimlin and his wife, Denise, recently moved back to his hometown of Sikeston, after living in O’Fallon for 30 years. Gimlin works as a respiratory therapist and his wife is a registered nurse in the Emergency Department at Missouri Delta Health Center in Sikeston. They have three children, ranging in age from 17 to 24.
Despite the distance, Gimlin said he has no problem making the occasional drive to visit Dr. Handa at St. Anthony’s. “I was in such a stressful situation when I was admitted to the medical center,” Gimlin said. “I had an infection that easily could have gone to my heart. But the whole crew at St. Anthony’s – in the operating room, in recovery, in my patient room – everybody was right there, taking care of me the whole way. They really were amazing – it was very impressive.”
Dr. Handa credits St. Anthony’s for its decision to invest in the specialized laser lead extraction equipment. “Not every hospital has this technology, and there is a growing need for device upgrades,” he said. “People are living long and patients are getting these devices at a younger age, so the potential for needing lead extraction in the future is growing. We want to be able to meet that need here at St. Anthony’s.”
Dr. Handa is a member of Metro Heart Group. To contact him, call St. Anthony’s Call Center at 314-525-4002 or 800-554-9550 or go to the online directory.
For information, please call our Health Access Line at 314-ANTHONY (268-4669) or 800-554-9550 or visit our find a physician online.
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