Unique procedure gives pacemaker patients options

For the 3500 Carle patients with pacemakers or defibrillators, getting the devices implanted means the opportunity to live for decades. But eventually the device and wires to the heart (called leads) can wear out or get infected.

In years past those patients would have to travel out of town for surgery or they would require additional leads in the heart to take over the job of the old leads. Today, Carle Heart and Vascular Institute offers patients a less invasive procedure that not only allows for the removal of those old leads but also gives patients the option of having the entire device replaced.

Anuj Garg, MD, is an electrophysiologist and is fellowship-trained in such procedures.

“It’s a procedure called a lead extraction, which is done mainly for two reasons,” Dr. Garg said. “One would be infection of the device where the pacemaker and wires would have to be removed from the heart. The second would be if more wires are needed to an existing device, but there is not enough space in the vein for additional leads.

“Instead of invasive heart surgery, I use a catheter. I use specialized tools, which go over the old wires and removes scar tissue. I can then remove the wires. Once we remove the old wires, I can install the new pacemaker with new wires. Patients can go home the next day.”

Doug Haig (pictured) of Urbana has had a pacemaker for 10 years. He developed an infection around the device and needed a new pacemaker and wires. Dr. Garg performed the procedure.

"There were no problems. I slept through the whole procedure," Haig said. "And, I'm glad I could stay close to home and not have open-heart surgery."

Before Dr. Garg came to Carle, people had to go to Chicago or St. Louis for the less-invasive procedure.

It takes a steady hand to perform the work—something the rest of the surgery team learned recently.

Adrienne Beers, RN, works with Dr. Garg during surgery, and she and the rest of the team practiced the pacemaker procedure on apples. The apple simulated scar tissue often found in the veins and heart.

“One of the tools has ‘teeth’ that rotate to remove scar tissue and frees the wires,” Beers said. “We used the tool on an apple, placed the end with the teeth on the apple and placed holes with the equipment.

“It was a lot harder than it sounds,” Beers said. “We knew Dr. Garg has to be careful when he removed the wires—we didn’t know just how careful. The whole surgery team has a better understanding of how we can support the surgeon in the operating room.”

Dr. Garg has a back-up plan at the ready if a patient should need an additional level of care. 

“There is an open-heart surgery team standing by in case we run into any complications getting a wire out,” Dr. Garg said.

Dr. Garg suggests people with pacemakers talk to their doctor about the best way to take care of their device and their health.

"Living with a pacemaker is a commitment, and that’s why it’s important we help people with pacemakers maintain their quality of life," Dr. Garg said.