The community of electrophysiologists specializing in lead management and extraction is small and scattered, but a new platform is connecting them in ways they never imagined.
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LEADconnection.org is a website supported by Cleveland Clinic and run independently by a handful of its electrophysiologists. Free from commercial sponsorship and open to physicians, lead management professionals and patients worldwide, the site is designed to serve as a central resource for lead management information.
“Everything relevant to cardiovascular implantable electronic devices (CIEDs) is discussed on this site,” says Bruce Wilkoff, MD, Director of Cardiac Pacing and Tachyarrhythmia Devices at Cleveland Clinic, who spearheaded the website’s development.
“We need a platform where people can find the information they need, meet, have clinical dialogue, learn techniques, express concerns, post cases and questions, and get feedback,” he explains. “We want LEADconnection.org to be the place where these discussions occur.”
A unique one-stop shop, the site also features webinars, podcasts, safety alerts, relevant literature, clinical trial information, meeting calendars, patient education materials, clinical “tips and tricks” and news stories about lead management and extraction. Much of the content can be freely accessed by anyone; registration is required to participate in discussions.
LEADconnection.org replaces a site that Dr. Wilkoff developed in 2015 but was unable to dedicate the time and resources required to keep it active. When he recently received an endowed chair, he used the funds to create, staff and launch the site he had long envisioned.
With CIED technology proliferating, electrophysiologists are seeing a steady stream of patients presenting with broken or infected leads and devices. Yet the difficulties associated with conducting randomized controlled trials to evaluate these problems means that most studies are observational. This has left key issues such as risk stratification unaddressed.
Any physician can post a case or questions on LEADconnection.org and receive input from colleagues, notes Thomas Callahan, MD, another Cleveland Clinic electrophysiologist who is involved with the website’s operation. “Data show that lead extraction for infection is important and helpful, but is it always the best option?” he asks. “Are some high-risk patients better served with surgery or chronic antibiotic therapy? Which tools are best in specific scenarios? It’s important to have a community resource where we can talk about what works and doesn’t in our practices.”
Aldo Rinaldi, MBBS, MD, a cardiology consultant at St Thomas’ Hospital, London, and Cleveland Clinic London, is part of a large lead extraction program serving patients in the United Kingdom. He participates with Dr. Wilkoff on LEADconnection.org and understands the value of the website to practitioners who may not have subspecialist colleagues at their own hospital with whom they can discuss difficult lead-related cases.
“Lead extraction is potentially complicated and the procedures can be high-risk,” Dr. Rinaldi says. “Certain patients may have unusual anatomy or leads that are difficult to remove. In these cases it is useful to have perspectives from other practitioners on what could be a difficult decision, particularly if you don’t have a high degree of experience in such cases yourself.”
“A practitioner undertaking lead management can have a conversation with the broader community and discuss which approach may be best for a particular patient,” Dr. Callahan adds. “With LEADconnection.org, distance is erased.”
With many questions about lead management remaining to be solved, LEADconnection.org also offers a place where problem solvers can find the information they need to develop solutions.
The ability to discuss issues of concern with colleagues is a key reason why physicians attend medical meetings. With LEADconnection.org, these discussions can take place year round at no charge. Over time, this should improve the ability of lead management specialists to deliver a higher level of care regardless of where they practice.
“If we are going to raise the level of care worldwide and end death and suffering from heart rhythm disorders, it cannot be limited just to practitioners who go to medical meetings,” says Dr. Wilkoff.