Dr. Jamil Bashir performed the 1,000th lead extraction at St. Paul's.

Beating Hearts

Promise Magazine: Fall/Winter 2016

Although skilled at the procedure, Dr. Jamil Bashir, a cardiac surgeon at St. Paul’s, says the best-case scenario would be eliminating laser lead extractions entirely.

Leads are wires attached to the heart that enable an implantable defibrillator to detect and correct irregular heartbeats. The leads are quickly incorporated into the heart and blood vessels with fibrous tissue and then cannot be removed without special techniques. Leads are often removed to avoid infection or when they fail.

Dr. Bashir removes the leads with an excimer laser, threading it around the lead and into the heart, and then firing when it meets the scar tissue. The objective is to destroy the scar tissue in which the lead is embedded so that it can be safely removed.

In 1994, laser lead extraction revolutionized the procedure – which typically required open-heart surgery – as a minimally invasive alternative. Dr. Bashir performed the 1,000th laser
lead extraction at St. Paul’s in fall 2016.

St. Paul’s currently has the largest laser lead extraction program in Canada and is a major centre of research and innovation in the field. Thanks to donors, St. Paul’s Foundation regularly supports the program, most recently in 2014, with the purchase of a new excimer laser.

In 2014, Dr. Bashir led St. Paul’s into a new era by helming the team that implanted the hospital’s first Subcutaneous Implantable Cardioverter Defibrillator, known as the S-ICD. “It’s wonderful to work at a hospital like St. Paul’s,” says Dr. Bashir. “Research and innovation are embraced here.”

Like the traditional implantable defibrillator, the S-ICD fires the same corrective shock that resets the arrhythmic heart. The S-ICD, however, doesn’t require wires to be attached to the heart at all – it uses electrodes placed just under the skin.

Just as laser lead extraction became the preferred alternative to open heart surgery 20 years ago, Dr. Bashir and the dedicated team of cardiac specialists at the provincial Heart Centre at St. Paul’s are now embarking on the era of the S-ICD. Thanks to its easily accessed electrodes, the new implant and system eliminates the need for leads, and thereby their extraction from the heart.

“The S-ICD is able to sense the heart’s activity from the surface of the chest, which is the real genius of this technology,” says Dr. Bashir. “And here at St. Paul’s, we have the largest program in Canada implanting these devices.”

“It’s about continuously improving patient care. Ten years ago it was just about lead extraction, and now it’s about improving the standards for pacemakers across the province,” says Dr. Bashir.