Harrington Heart & Vascular Institute Innovations - Winter 2017 - View Full PDF
DINA SPARANO, MD
Director, Lead Management Program, University Hospitals Harrington Heart & Vascular Institute; Assistant Professor of Medicine, Case Western Reserve University School of Medicine
For the growing number of patients with cardiac implantable electronic devices (CIEDs) such as pacemakers and defibrillators, teamwork in their care is essential to achieving the very best outcomes. While many physicians implant these devices, fewer specialize in their extraction or management over time.
New approaches are needed to meet the increased need and bring new options to this patient population. To that end, the Electrophysiology Center at University Hospitals Harrington Heart & Vascular Institute has created a Lead Management Program, which offers expert consultation and management services. The program’s expert staff offers a comprehensive approach to the complex care these patients require, for simple or complex cases.
Lead management helps address challenges such as infection, device malfunction or the need for a device upgrade. Patients may experience issues related to venous access and occlusion, with inactive leads left inside the body, or with older systems incompatible with MRI procedures that may require replacing.
“We think of our work as ‘lead management’ because we believe that considering a full range of options is the right approach for the diverse needs of patient with CIEDs,” says Dina Sparano, MD, Assistant Professor of Medicine at Case Western Reserve University School of Medicine, and the Lead Management Program Director. “Sometimes the right answer is not lead extraction but a less invasive intervention.”
In cases when lead extraction is indicated, the UH team ensures that surgical support is present during the procedure. Throughout the case the surgical team is involved or on standby, along with dedicated cardiac perfusionists. The safety and efficiency of lead extraction procedures have improved dramatically and continue to do so as technology improves, as operators gain more experience and with the involvement of a specialty Lead Management Program team. 
The program offers a Lead Management Clinic for referred patients and their families to have in-depth conversations about their cardiac devices and receive a comprehensive consultative experience. Dr. Sparano compares this approach to that of oncology tumor boards to discuss the best approach to current cases.
“The program doesn’t replace referring physicians’ care,” Dr. Sparano says. “We are partners in care and have specific expertise to offer when managing devices.”
In addition to Dr. Sparano, the Lead Management Program team includes dedicated electrophysiologists Judith Mackall, MD, and Sergio Thal, MD; cardiac surgeons; anesthesiologists; infectious disease specialists; and University Hospitals’ exemplary lab and operating room nurses and staff. Each patient’s team also includes the referring physician, and all cases are discussed among the involved disciplines.
In the last year, the volume of lead extractions has grown at University Hospitals, with strong outcomes due in part to these collaborative relationships with other departments.
“Our number of cases exceeds the benchmark for national standards of expertise,” Dr. Sparano says. “We have a zero mortality rate, and our complication rates are equal to the national rates of other high-volume centers.” Across the University Hospitals system, more than 10,000 clinic checks of cardiac devices occur each year, and even more cardiac device patients may be able to benefit from this comprehensive approach to care.