Lead Extraction

Pacemaker and implantable cardioverter defibrillator (ICD) devices consist of:

• A pulse generator (a small computer with a battery)
  One or more leads (wires connecting to the heart)

Leads attach to the heart muscle, where scar tissue forms to anchor them securely. Your pacemaker or ICD sends impulses through the leads to your heart to stabilize or correct a slow or fast rhythm.

References
1.    Bude, Boyé NG, Belott PH. Pacemaker and defibrillator lead extraction. Circulation. 2011;123:e378–e380. DOI: 10.1161/CIRCULATIONAHA.110.987354

Lead extraction is a medical procedure to remove one or more lead wires that attach a pacemaker or ICD to your heart. The most common reason for lead extraction is an infection. If any part of the system gets infected, the pulse generator and leads often need to be completely removed to fully treat the infection.

Another reason is that over time, leads can fail. For example, a break can occur in the metal wire or insulation that surrounds the wire. Sometimes, doctors will abandon the broken lead and implant a new one next to it. However, because veins are small, you may need to have a lead extraction to remove the broken leads and make space for new ones.

Removing leads through the veins (called transvenous lead extraction) is preferred over open-heart surgery.

References
1.    Bude, Boyé NG, Belott PH. Pacemaker and defibrillator lead extraction. Circulation. 2011;123:e378–e380. DOI: 10.1161/CIRCULATIONAHA.110.987354
2.    Perez AA, Wold FW, Tang PC, Carrillo RG. Transvenous lead extractions: current approaches and future trends. Arrhythmia and Electrophysiology Review. 2018;7(3):210–217. DOI: https://doi.org/10.15420/aer.2018.33.2
 

You might need lead extraction for several reasons, including:

• Infection
• Lead failure
• Removal of abandoned leads, which may interfere with new leads that need to be placed
• The need for a new pacemaker or ICD because of manufacturer upgrades or recalls
• Abnormal heart rhythms (arrhythmia) triggered by a lead
• Blood clots forming on a lead that can’t be treated by other means
• Chronic pain at the insertion site that can’t be managed by other means

References
1.    Bude, Boyé NG, Belott PH. Pacemaker and defibrillator lead extraction. Circulation. 2011;123:e378–e380. DOI: 10.1161/CIRCULATIONAHA.110.987354
2.    Perez AA, Wold FW, Tang PC, Carrillo RG. Transvenous lead extractions: current approaches and future trends. Arrhythmia and Electrophysiology Review. 2018;7(3):210–217. DOI: https://doi.org/10.15420/aer.2018.33.2
 

The procedure is usually performed under general anesthesia. A small incision is made below your collarbone to access the leads through your subclavian vein. Sometimes, if a lead is new and not a lot of scar tissue has formed around it yet, it can be removed with simple traction. Otherwise, doctors use special tools known as sheaths that surround the lead and free it from scar tissue as they move toward the heart. In some cases where the subclavian approach is not possible, an incision is made in the groin to remove the leads from the femoral vein.

References
1.    Bude, Boyé NG, Belott PH. Pacemaker and defibrillator lead extraction. Circulation. 2011;123:e378–e380. DOI: 10.1161/CIRCULATIONAHA.110.987354
2.    Perez AA, Wold FW, Tang PC, Carrillo RG. Transvenous lead extractions: current approaches and future trends. Arrhythmia and Electrophysiology Review. 2018;7(3):210–217. DOI: https://doi.org/10.15420/aer.2018.33.2
 

Typically, lead extraction takes two to six hours. Patients generally need to stay in the hospital for at least one night after the procedure.

References
1.    Bude, Boyé NG, Belott PH. Pacemaker and defibrillator lead extraction. Circulation. 2011;123:e378–e380. DOI: 10.1161/CIRCULATIONAHA.110.987354
 

While generally safe, lead extraction carries some risks. Some examples include:

• Excessive or abnormal bleeding
• Infection
• Damage to the heart or surrounding blood vessels
• Complications from anesthesia
• A broken lead or lead fragment that needs to be removed
• Blood clot in the lung (pulmonary embolism)
• Stroke

References
1.    Bude, Boyé NG, Belott PH. Pacemaker and defibrillator lead extraction. Circulation. 2011;123:e378–e380. DOI: 10.1161/CIRCULATIONAHA.110.987354
2.    Perez AA, Wold FW, Tang PC, Carrillo RG. Transvenous lead extractions: current approaches and future trends. Arrhythmia and Electrophysiology Review. 2018;7(3):210–217. DOI: https://doi.org/10.15420/aer.2018.33.2
 

After the procedure, you’ll need to stay in the hospital for at least one night so your doctors can:

• Monitor your vital signs, such as your heart rate, rhythm and breathing
• Give you pain medicine if needed
• Do a follow-up chest X-ray

Once you are able to go home, you can help manage your recovery by:

• Taking the full course of any prescribed antibiotics to prevent infection
• Managing temporary swelling, bruising or pain with medications your doctor prescribes
• Changing the bandages over your surgery site every day
• Limiting strenuous activity and heavy lifting
• Following all other specific post-operative instructions provided by your doctor

It is important to call your healthcare provider if you experience:

• Increased swelling or redness
• Fever
• Unusual bleeding or drainage

References
3.    The Lead Extraction Procedure. Stanford Medicine Health Care. Accessed July 29, 2024. https://stanfordhealthcare.org/medical-treatments/p/pacemaker-icd-lead-…

 

Lead extractions are performed by an experienced team including an electrophysiologist, an anesthesiologist, an X-ray technician, nurses, technicians and other support staff.

References
2.    Perez AA, Wold FW, Tang PC, Carrillo RG. Transvenous lead extractions: current approaches and future trends. Arrhythmia and Electrophysiology Review. 2018;7(3):210–217. DOI: https://doi.org/10.15420/aer.2018.33.2

 

This depends on your individual situation. In some cases, an ICD lead or pacemaker lead may need to be extracted due to mechanical failure or other complications. In those cases, a new lead will often be implanted during the same procedure or shortly after. If there is an infection, your doctor will carefully look at your response to antibiotics and further infection risk before implanting new leads.

References
4.    Aih F. Forrest S, de Ambroggi G, Capato R, Lopes P. Practical considerations for cardiac electronic devices reimplantation following transvenous lead extraction due to related endocarditis. J Clin Med. 2023;12:6908. DOI: https://doi.org/10.3390/jcm12216908
 

>Your health care team will provide specific instructions, but generally, you may need to:

• Stop taking certain medications
• Fast for several hours before the procedure

If you would like to schedule a consultation with our expert team, please request an appointment.

References
2.    Perez AA, Wold FW, Tang PC, Carrillo RG. Transvenous lead extractions: current approaches and future trends. Arrhythmia and Electrophysiology Review. 2018;7(3):210–217. DOI: https://doi.org/10.15420/aer.2018.33.2
3.    The Lead Extraction Procedure. Stanford Medicine Health Care. Accessed July 29, 2024. https://stanfordhealthcare.org/medical-treatments/p/pacemaker-icd-lead-…