Lead Extraction

Leads are insulated wires that run from the heart to surgically implanted cardiac devices such as pacemakers and implantable cardioverter defibrillators (ICDs). Leads are designed to stay attached to the heart permanently, where they are held in place by scar tissue. However, sometimes leads need to be removed. The procedure to remove them is called lead extraction.

Who Needs a Lead Extraction?

The most common reasons for lead extractions are:

• Device or heart valve infection: Lead extraction is often needed if any part of a pacemaker or ICD becomes infected. Usually both the pulse generator (the implanted device that sends electrical pulses to the heart) and the leads must be removed. Infection of a heart valve may also require generator and lead extraction.
• Broken leads: Sometimes leads break, often because the material insulating the wire breaks down or the wire itself fractures. Not all broken leads need to be removed. In some cases, a non-functioning lead can be unplugged and replaced with a new lead. When a new lead is required and there is no opening in the vein to insert a new one, the broken lead is removed.
• Other less common reasons for lead extraction include:
  • Recalls on specific pacemaker or ICD leads.
  • Clot formation on a lead that obstructs a vein.
  • A lead that triggers abnormal heart rhythms or other complications.
  • An upgrade to a newer device system.

What to Expect Before, During and After the Procedure

Before the procedure

Your healthcare provider will talk to you about what medicines you should or shouldn’t take prior to your procedure and when to stop taking them. You’ll also be given instructions on what not to eat or drink the night before your procedure.

During the procedure

A lead extraction typically takes 2 to 4 hours. You are given medication (anesthesia) to help you sleep deeply and painlessly through the procedure. The doctor makes an incision under the collarbone or in the groin. The doctor inserts a special sheath (tube) into the incision and guides it through a vein to the lead(s). After instruments at the sheath’s tip are used to free the leads from the heart, the leads are safely removed from the body. If you require new leads, your team can implant them at this time.

After the procedure

You’ll be monitored for several hours in a recovery room. You may receive pain medicine if you need it. You'll likely spend at least one night in the hospital, and usually you’ll be monitored overnight in the intensive care unit, although time in the hospital varies. You'll require a follow-up chest X-ray to make sure any new leads you received are placed in the right position. Before you leave the hospital, you’ll be given instructions concerning medications, exercise, diet and wound care. After discharge, you should be able to return to light activity soon. You may have stitches or staples that need to be removed. Call your provider if you experience increased swelling, bleeding, drainage or a fever. Be sure to attend all your follow-up appointments.

Benefits of Lead Extraction

The benefits of lead extraction can include:

• Restoring the function of your pacemaker or ICD if the lead was malfunctioning.
• Improving pacemaker or ICD efficiency.
• Relief from arrhythmias that were caused by the broken lead.
• Restored blood flow if scar tissue or blood clots from a lead caused a blockage.
• Clearing infection if the lead or device were infected.

Potential Complications of Lead Extraction

As with any surgical procedure, there are certain risks, including:

• Anesthesia complications.
• Lead breakage.
• Major bleeding requiring a blood transfusion.
• Perforation of the heart with the lead tip.
• Tearing a blood vessel.
• Blood leakage around the heart.
• The need for emergent open heart surgery to correct any of the above complications.

Follow-up Care

Your healthcare team will schedule you for regular follow-up appointments to check your cardiovascular health and, if applicable, your new leads and cardiac device.