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Advanced Cardiac Procedure Performed at the Asheville VAMC

Dr. Anil Goli and Veteran Stanley Mitchell  (Photo by Jay Coble)Dr. Anil K. Goli, Director of Electrophysiology Service, with Veteran Stanley Mitchell, one week after successfully completion of the first laser lead extraction at the Charles George VAMC.

Everyone has probably heard the expression, “Nothing lasts forever.”  It's accepted as a simple truth, but one that can have awful complications.  These awful complications are especially true when we are talking about advanced medical devices.

Consider the pacemaker, intended to regularly pace the heart, or defibrillator, which is delivering electrical shocks aimed at terminating abnormal, high-risk irregularities of the heartbeats.  These devices have been in common use for decades now with thousands of our neighbors in Western NC  walking around with these devices implanted just under their skin.  These devices have fine electronic wire leads that are carefully threaded from the battery, which is located under the skin of the patient's chest, through the patient's central veins to chambers of the heart.  When an absence of a heartbeat or an irregular heartbeat is detected, the devices send an electric current through the leads into the patient's heart to activate it or shock it back into a regular rhythm.  The devices can remain in a patient's body for years without complications.

Well, what do you do when a wire lead breaks or is recalled because of a manufacturing defect?  Until recently, removal had to be done by way of high-risk, complex open heart surgery. Veterans who are enrolled at the Charles George VA Medical Center are fortunate, because the VAMC is now one of a handful of medical facilities in the U.S., and the only medical center in Western North Carolina, where they can undergo a simple, much less invasive procedure called Defibrillator Lead Extraction. 

Dr. On Topaz, consulting Professor of Medicine, Duke University School of Medicine and Chief of Cardiology, at the Asheville VAMC explained this unique procedure.  “Simply put, it is the removal of electronic wires from the body” by using a medical laser.  The procedure is done with only a local anesthetic and a mild sedative.  The doctor begins by isolating the battery for the pacemaker or defibrillator and then inserts a cardiac laser catheter that slides inside the central veins, over the dysfunctional lead, and guides it towards the tip of the lead anchored in the heart chamber.  Once the laser is in place and activated, it dissolves the old tissue in about a minute, allowing for easy removal of the dysfunctional lead.  The doctor can then pull the lead out and use the path created by the laser to insert a new wire lead.  Patients recover quickly, far faster than with open heart surgery, and are usually discharged the following day. Doctor Topaz said on Sept. 9th that the division of cardiology at the Charles George VAMC now “provides this sophisticated treatment similar to some of the most advanced medical facilities in the United States.”  Dr. Anil K. Goli, Director of the Charles George Electrophysiology Service, had just successfully completed the first lead extraction under the supervision of Dr.  Roger Carillo, “a leading authority from the University of Miami, who is a nationally respected cardiac surgeon specializing in removal of dysfunctional electrophysiology devices”.

Doctor Goli attended medical school in India and completed medical training at Johnson City, Tennessee, followed by an electrophysiology fellowship at the prestigious electrophysiology center of the  Case Western University in Ohio.  Over the years, Dr. Goli has gained extensive experience and reputation in the field of electrophysiology.  Before performing the unique laser procedure, Dr. Goli underwent three dedicated training sessions with Doctor Carillo at the University of Miami.

Stanley Mitchell, the first Veteran to benefit from the procedure at the Charles George VAMC, is an Air Force Veteran from Spartanburg, S.C.   He is a musician and artist who works in bronze.  Mitchell said that the procedure was painless; he “only felt some pressure near the insertion point as I woke up from the procedure”.  For Mr. Mitchell the hardest part was prior to the procedure.  “Having this thing in my chest and not knowing what was wrong with it caused a lot of anguish; however, Dr. Goli helped me understand what was wrong and how he was going to fix it.” Mr. Mitchell said.  “Dr. Goli is one of the most fantastic doctors I have ever met!”

The procedure went smoothly, Mr. Mitchell was discharged the following day, and he is now resting comfortably at home.  Mr. Mitchell also said, “I had a choice of where to go, and the reason I chose the VA in Asheville is because I was told they have one of the best cardiology departments in the area.  I believe that even more so now.  The staff is wonderful. They're good to me, and they go out of their way for me.” He also credits the advanced medical laser equipment that the Center has and the training that staff , has received.

Doctor Topaz is proud of the physicians, nurses, and technicians who work with him and what they have accomplished.  “The only other VA centers in our area that are doing this advanced procedure are Durham and Richmond.”

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