Study: Age Not a Factor in Heart Wire Removal

Most doctors agree that age is a risk factor during surgical procedures: Older patients generally have a greater chance for complications than their younger counterparts.

In most cases, anyway.

There are some procedures, however, where age is irrelevant. Removing implanted pacemaker and defibrillator wires in heart muscle by laser is a prime example. Research has proven the procedure is as safe for patients aged 80 and older as it is for younger people. “We wanted to know if age was a risk factor in this procedure, and if octogenarians fare as well as younger patients,” said Roger G. Carrillo, M.D., senior study author and chief of surgical electrophysiology at the University of Miami Hospital (in Miami, Fla.). “We found no difference in risk.”

Carrillo’s findings recently were reported in Circulation: Arrhythmia & Electrophysiology, an American Heart Association journal. Carrillo and his colleagues studied the medical records of 506 patients who underwent laser surgery for lead extractions over a 5.5-year period that ended in June 2009. Researchers divided the patients into two groups—388 adults younger than 80 (the average age in this group was 64) and 118 people 80 and older (the average age among these individuals was 85). All patients received new leads within one week.

Among the study’s conclusions:
• Infection was the most common reason for lead extraction, but there was no important difference in infection rates between the two groups.
• Complications were not significantly different between the two age sets.
• Rates of high blood pressure, diabetes, coronary artery disease and congestive heart failure did not vary between the groups.
• More pacemakers had been implanted in octogenarians than those under 80—56 percent vs. 36 percent.
• Defibrillators were more common among younger patients—47 percent vs. 28 percent.

“This is an exciting study because it demonstrates that elderly people can go through laser lead extraction in a safer way,” noted Carrillo, who also serves as associate professor of clinical surgery at the university’s medical school.

More research is needed, though, before Carrillo can draw any final conclusions about age and lead wire removal from heart muscle. To confirm the findings, Carrillo will have to conduct a study with a greater number of patients aged 80 and older in several hospitals where doctors have little experience with laser extractions.

Laser removal of lead wires first was conducted in 1997. The procedure uses a catheter coated with optical fibers to conduct laser light that is threaded through a vein to the heart. Once positioned over a lead, a measured dose of laser energy removes scar tissue, enabling doctors to remove the wires. Most patients who undergo this procedure experience little or no complications but 1 percent to 2 percent develop infections or sustain damage to the wires that require removal (usually done with a gentle tug). Traditionally, doctors have been wary of using the procedure in octogenarians due to safety concerns.

About 3 million people in the United States rely on implanted pacemakers or defibrillators, and an additional 400,000 receive one of the lifesaving devices annually. Eighty percent of the devices are implanted in people older than 65.