Fixing bad connections (video)

You can think of Dr. Peter Belott as an electrician for your ticker.

For nearly four decades, Dr. Belott, medical director of the Electrophysiology Program at Sharp Grossmont Hospital, has performed surgeries to correct abnormal heartbeats in patients with arrhythmias. Devices, such as pacemakers and implantable cardioverter defibrillators (ICDs), are placed in patients whose hearts beat either too fast, too slow or irregularly. Sometimes these devices develop problems and need to be removed.

An example is when bacterial infection occurs or the device’s wires that connect to the heart fail. When this occurs, surgery to remove these damaged wires, or leads, may be needed.

Dr. Belott, an expert who has authored several medical textbook chapters and published studies on the subject, has become the go-to guy for lead extraction surgery. He performs roughly 50 lead extraction surgeries a year at Sharp Grossmont's Burr Heart & Vascular Center.

Leading with lasers
There are several ways to remove wires during surgery. One of the latest methods uses a laser. After making a small incision in the chest, the surgeon disconnects the pacemaker or ICD from its wire located in the vein. The laser, which is attached to a long, hollow tube, is then guided over the wire. As the tube makes its way through the vein and along the wire, it removes the scar tissue holding the wire to the vein walls. Once freed from the scar tissue, the surgeon carefully pulls out the wire.

The surgeon may either insert new wires, or if the cause is a bacterial infection, the wires are inserted at a later date after the infection has cleared.

“Lead extraction surgery is uncommon,” says Dr. Belott. “Typically, less than 1 percent of patients with pacemakers or ICDs nationwide undergo such surgery.”

Although rare, the surgery is not without risk. Complications may include blood vessel tearing, or bleeding into the chest or cavity around the heart. According to an American Heart Association report, co-authored by Dr. Belott, the rate of major complications was 1.6 to 2 percent, or approximately 1 in 50 patients.

“When I discuss the procedure with patients, I always take the time to explain and reiterate the risks,” says Dr. Belott. “At Sharp Grossmont, we have a team that is prepared for any complications that may arise.”

Smooth operation
The advantage of having an established lead management program at Sharp Grossmont is that formal measures and processes are in place to reduce complications and make the procedure safe. The hospital’s lead extraction surgical team regularly completes drills and is thoroughly prepared for various challenging situations should they occur.

Along with Dr. Belott who performs the surgery, the team is comprised of a cardiothoracic surgeon, cardiovascular anesthesiologist and other expert staff in the operating room. Because each patient case is unique, there are also various extraction tools, such as lasers, stylets, snares and other mechanisms, at the surgeon’s immediate disposal.

“Preparation is key,” stresses Dr. Belott. “Our patient outcomes are successful in part due to the experience and the time our team spends preparing for surgery well in advance of the patient entering the operating room.”

Watch the video above to learn more about lead extraction at Sharp Grossmont Hospital.

For the news media: To talk with Dr. Belott about lead extraction for an upcoming story, contact Erica Carlson, senior public relations specialist, at erica.carlson@sharp.com.