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Baylor Scott & White Heart and Vascular Hospital – Dallas Electrophysiology
Leadless pacers
Electrophysiologists on the medical staff at Baylor Scott & White Heart and Vascular Hospital – Dallas are able to place the world ’ s smallest pacemaker called the Micra™ Transcatheter Pacing System in patients . Cardiologists on the medical staff helped achieve US approval for the commercial use of the leadless pacemaker in 2016 . The size of a nickel or paperclip , the pacemaker represents the first entry in what is a new class of slender , minimally invasive pacemakers that rest entirely inside the heart .
This type of leadless pacemaker is placed directly into the right ventricle using a flexible tube the size of a large drinking straw , which is advanced into the heart from a small incision in the leg . Tiny bits of metal on the end of the pacemaker hook or screw into the heart tissue . This avoids the need for traditional pacemaker insulated wires called leads to deliver the pacemaker ’ s electric pulses . Leads have been called the “ Achilles ’ heel ” of pacemakers because they can wear out and create infection risk .
Device lead extraction
Electrophysiologists on the medical staff at Baylor Scott & White Heart and Vascular Hospital – Dallas frequently see patients who are referred to them with complex conditions needing removal of leads because of electrical malfunctions , blocked blood vessels or infection . In most cases , the leads can be removed using a catheter-based approach .
Left atrial appendage occlusion ( LAAO )
Atrial fibrillation ( AFib ) can decrease the heart ’ s pumping efficiency by as much as 30 %. Compromised pumping increases the risk of clots forming in the heart chambers , particularly the left atrial appendage ( LAA ). The LAA is pouch-shaped and about the size of the thumb . It is located on the top of the heart . LAA occlusion generally decreases the risk of stroke without the need for blood thinners .
Electrophysiologists on the medical staff have been successful with bringing the WATCHMAN™ device through clinical trials and post-FDA approval . Approved by the FDA in 2016 after years of research and clinical trials proving its effectiveness , the device is now a more commonly offered viable option for many patients who are unable to take blood thinners . The LAAO device is designed to prevent blood clots that frequently form in the LAA from traveling in the blood stream to the brain , lungs and other parts of the body . With this device , patients are generally released from the hospital after 24 hours . Medical follow-up continues over the course of time as patients decrease their blood thinner medication under the supervision of a cardiologist .
LAAO device is suitable for patients with nonvalvular atrial fibrillation who :
• Are at an increased risk for stroke and systemic embolism based on CHADS2 or CHADS2-VASc scores and are recommended for anticoagulation therapy
• Have an appropriate rationale to seek a nonpharmacologic alternative to oral anticoagulation , taking into account the safety and effectiveness of the device compared to warfarin
Total LAAOs ( FY20 ):
44
PATIENT EDUCATION AND SUPPORT
Wired for Life is an educational class for patients with implantable cardioverter defibrillators ( ICDs ). The electrophysiology team provides patients with guidance , encouragement and support on the use of their ICDs . Patients suffering from cardiomyopathy , congestive heart failure or who have experienced sudden cardiac arrest know that the ICD can be a life vest . A workshop for patients with ICDs is offered six times per year by clinical experts from Baylor Scott & White Heart and Vascular Hospital – Dallas .
Due to COVID-19 , the clinicians worked on a way to continue the classes through an online platform , Webex . Virtual classes are now scheduled for patients , family members and the community-atlarge . The classes are also open to anyone in the community who has an ICD — regardless of where the ICD was implanted .