A quarter century ago, doctors treating patients with implanted cardiac pacemakers had a big problem. Their patients were outliving the complex electrical devices that gave them an acceptable quality of life.
Pacemaker lead wires that deliver electricity to the heart broke, effectively stopping the pacemaker from functioning. Old leads could harbour sometimes-fatal infections that were difficult to treat if the lead was left in place and because these were such sick patients to begin with, no one had anticipated the need to extract faulty leads years or even decades later. After only a year or two, leads can become trapped in place by scar tissue and increasing amounts of calcium build-up, making extraction challenging.
Medicine had no standard tools or techniques for the procedure then. One pioneer in the field says removing a bad lead back then was “a dark art.”
However, by the mid-1980s, physicians, in cooperation with industry, began developing specialized mechanical lead extraction tools such as the locking stylet and the telescoping sheath to improve the procedure. They honed in on standardized extraction techniques. Working with Cook Medical, they pioneered a new medical procedure – cardiac lead extraction. This year marks the 25th anniversary of the first commercially available mechanical lead extraction devices.
As more pacemakers and defibrillators are implanted each year, the need for lead removal continues to grow. Currently, there are more than seven million cardiac devices implanted in patents worldwide. Each year another one million patients receive a pacemaker or defibrillator. Patients are receiving implants at younger ages, increasing the length of time these devices are implanted. In the next year alone, 10-15,000 cardiac leads will require extraction.
Charles Byrd, Charles Love, Ray Schaerf and Bruce Wilkoff and Cook Medical’s Lou Goode were among the first to see the need.
“This was a time when a band of physicians were working to fix a very serious medical problem and they came to us for help,” says Goode, now global leader of Cook Medical’s lead extraction clinical division. “And by working together, we created a standardized set of tools to extract leads more safely, and the clinical procedure to use those devices.”
“We have such better tools now,” says Wilkoff. “In the beginning, before standardized devices or techniques, every procedure was an adventure.”
“Pacemaker technology will continue to change and so will the procedure. In the future, more and more devices will be implanted. Someone will need to figure out how to retrieve these devices, and we’re up to the challenge,” says Goode.