The Cooper Heart Institute, one of the premier arrhythmia management programs in the region, has recently been selected as one of 12 Centers of Excellence in the nation for laser-assisted endocardial lead extraction. Laser technology has transformed the safety and efficacy of transvenous cardiac pacing lead removal for the nearly 10,000 patients annually who require extraction, a procedure long associated with a high incidence of life- threatening complications.
Institutions and teams are chosen as Centers of Excellence by exhibiting the highest standard of practice, predictable outcomes, and world-class medical care in laser lead extraction and lead management.
In addition, a Center of Excellence must also include a multi-disciplinary health care team, led by the extracting electrophysiologist who manages all aspects of a patient’s lead.
Led by John A. Andriulli, DO, Director of the Cooper Electrophysiology Laboratory and Arrhythmia Device Program, the Cooper program provides outside physicians and their teams with didactic and observational training for laser lead extraction.
“Cooper has a uniquely dedicated team that includes an electrophysiologist, a CT surgeon, CT anesthesiologist, perfusionist, and CT and EP nurses to perform the laser-assisted lead extraction,” says Dr. Andriulli. “Outcomes in lead extraction are closely linked to expertise and experience. At Cooper we have performed over 150 extractions since our program began in mid 2010, without a single serious complication, more than any other institution in New Jersey.”
The need for safe, effective lead extraction has risen as the use of device implantation for arrhythmia management has increased. The Heart Rhythm Society (HRS) Class I indications for lead extraction remain limited to:
- Infection, defined as documented system infection evidenced by valvular endocarditis, lead endocarditis, or sepsis, as well as patients with evidence of pocket infection, pocket abscess, device erosion, and skin adherence.
- Life-threatening arrhythmias secondary to retained leads or lead fragments in functional or non-functional leads.
- Endocardial leads that due to their design, fracture or failure, may pose an immediate threat to the patient if left in place.
- Retained leads that interfere with the operation of implanted cardiac devices.
Onsite cardiac surgery back-up is required to perform laser lead extraction, and, until recently, all extraction procedures have been performed in the Cooper operating suites. However, extensive technological upgrades have been completed to enable laser lead removal cases to be moved from the Cooper operating suites to the new hybrid catheterization laboratory.
“To perform lead extraction outside of the operating room setting, the lab needed to be retro-fitted to accommodate cardio-pulmonary bypass and advanced anesthesia capabilities,” says Dr. Andriulli. “Cardiac anesthesia at Cooper is under the direction of Muhammad Muntazar, MD, and staff, and is the finest in the Delaware Valley. The combination of exceptional anesthesia expertise, renovated laboratory facilities and highly-trained staff provides a setting at Cooper to perform procedures on the most complex patients.”
For more information about laser lead extraction or to refer a patient for consultation, please call 856.342.2034.