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over the lead. Using pulsed laser energy, Dr. Goldstein vaporizes the scar tissue around the leads and removes them. In certain situations, new implants can be placed at the time of the procedure. "Laser lead extraction is a high-risk procedure, and only centers with spe- cially trained personnel perform it," Dr. Goldstein explains. "We offer it as part of our comprehensive service line to bring such care to the local community hospital and prevent the need for travel to tertiary centers for treatment." For the same reason, Lake Health also offers subcutaneous implantable cardioverter defibrillators for patients with arrhythmias. S-ICD — The New Standard of Care? FDA-approved in September 2012, S-ICD is now considered to be a first-line defense for patients with life-threatening ventricular tachyarrhythmias. Unlike the traditional ICD, this advanced technology prevents sudden cardiac arrest without the need for leads to be placed into the heart muscle. "This is a huge leap forward in terms of patient safety," Dr. Goldstein explains. "Since the device functions without touch- ing the heart and blood vessels, infection, wear and tear on the leads and other complications become less of an issue." He explains that with traditional ICDs, the risk of infection is significant, espe- cially for dialysis patients who often require frequent access to venous blood through fistulas. "If the infection affects the heart, the entire device must be removed, and that's a risky procedure," he says. "S-ICDs allay these risks." The pulse monitor/ICD part of the device is implanted on the side of the chest below the armpit via a minimally invasive procedure that requires three small inci- sions. It is connected to the electrode, which is implanted under the skin along the rib margin to the breastbone. Patients typically go home the next day and resume normal activities within a week. "For patients who don't require the regular stimulation of a pacemaker, this device has the potential to become the new standard of care," said Dr. Goldstein. "Additionally, it provides a less invasive option for patients who would otherwise not be candidates for a traditional ICD due to blocked veins or an increased risk of infection, such as individuals with diabetes or those on dialysis." World's Smallest ICM Implant For patients with recurrent syncope (fainting) from unknown causes, Lake Health now offers a miniature wireless remote monitor — the Medtronic Reveal LINQ Injectable Cardiac Monitor (ICM). At approximately one-third the size of a AAA battery, it is the smallest ICM in the world. In February 2014, Dr. Goldstein was reportedly the first in Northeast Ohio to implant it in a patient — an 81-year- old man. "This new technology enables long-term remote monitoring, so we can quickly and accurately diagnose a patient's underly- ing cause of dizziness, palpitations and syncope," says Dr. Goldstein. The device operates without the need for wires or patches outside the body. It weighs only a few ounces and takes seconds to implant through a simple injection delivered under local anesthetic. Electrodes within the ICM record the heart's electrical activity and detect irregularities using the same method as a standard electrocardiogram. "The size and wireless capacity of the device along with the ease of insertion are game changing," says Dr. Goldstein. The device has a boosted memory capac- ity and allows continuous monitoring of heart rhythms for up to three years. It uses cellular signals to transmit data to the hospital via the CareLink Network. "This new device alerts us to patients having cardiac episodes, no matter where in the world they are," Dr. Goldstein says. "Even if patients are abroad, the device sends information to us, and we can see the rhythm on our computers." For more information about Lake Health's Cardiac Electrophysiology Department, visit www.lakehealth.org, or to refer patients, call 440-602-6735. ■ With the subcutaneous implantable cardioverter defibrillator (S-ICD), there's no need for leads to be placed into the heart muscle. The pulse monitor/ICD part of the device, which Dr. Goldstein displays here, is implanted on the side of the chest below the armpit via a minimally invasive procedure that requires only three small incisions. It is connected to the electrode, which is implanted under the skin along the rib margin to the breastbone. 2 0 1 4 J U LY/AU G U S T ■ M D N E W S . CO M ■ MD NEWS Cleveland/Akron/Canton | 2 7