Safety of the Excimer Laser in LASIK and PRK for Patients with Implantable Cardiac Devices: Our Clinical Experience in the Past Two Decades

Continued high prevalence in cardiac morbidity in the US has led to more refractive surgical candidates with cardiac implantable electronic devices (CIED), although the Food and Drug Administration (FDA) studies have consistently excluded such populations during laser-assisted in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) evaluations. Major manufacturers have discouraged laser eye surgery in patients with CIEDs until recently when Medtronic and St. Jude, the two largest manufacturers of such devices, approved LASIK surgery with recommendations to shielding the CIED with a magnet and closely monitoring the heart rate during the surgery.[1] We aim to share our insights and experiences over the years, hopefully mitigating some of the concerns in clinical practice. The excimer laser can electromagnetically interfere with the CIEDs and cause changes in a surgical setting[2] with potential adverse effects including cardiac stimulation inducing ventricular tachycardia or ventricular fibrillation, unexpected movement of the body, and interference with the ability of the CIEDs to adequately monitor for potential arrhythmias.[3] The factors affecting electromagnetic interference depend on the frequency of the emitting device, the distance between the devices, and the amount of shielding of the affected device.[2] Particularly, with excimer use, L’Esperance et al[4] demonstrated that nearly all of the 193 nm energy is absorbed by the cornea indicating that the frequency of light emitted by the ablation process may not cause significant interference with the CIEDs. Furthermore, a recent study by Sher et al[5] demonstrated that in-vitro operation with the three most commonly used ophthalmic lasers (VISX Star S4 Excimer Laser, Lumenis Selecta II Glaucoma Laser, and Laserex Ultra Q Photodisruptor) did not lead to oversensing, inappropriate therapy, or change in the programming of the Atlas II+ implantable cardioverter defibrillators (ICDs) or the St. Jude Medical Victory pacemaker.