Understanding Lead Extraction

Outline of man's chest showing pacemaker in chest with leads going into heart chambers.Lead extraction is the removal of wires from your heart. The wires are part of an implanted cardiac device. This is a small machine put into your chest that helps your heart keep a normal rate and rhythm.

What are implanted cardiac devices?

Many people have implanted cardiac devices. These include pacemakers, implantable cardioverter defibrillators (ICDs), or a combination of both. Pacemakers can help treat slow heart rhythms. ICDs stop dangerous rapid heart rhythms.

Both pacemakers and ICDs have 2 main parts:

  • Pulse generator. This is a small computer with electric circuits and a battery that is implanted in the chest underneath the skin.

  • Leads. These are wires that run between the pulse generator and your heart.

Leads can stay attached to the heart permanently. But in some cases, they need to be removed. This is called lead extraction.

Why lead extraction is done

The most common needs for lead extraction are:

  • Infection of any part of the cardiac device

  • Infection of a heart valve

  • Broken or malfunctioning leads

Other reasons for lead extraction are less common. These include:

  • Dangerous leads (such as a protruding wire)

  • Recall on a certain type of defective pacemaker or ICD lead

  • Blood clot or scar tissue on a lead that blocks a vein

  • A lead that is causing abnormal heart rhythms or other problems

  • A lead that is no longer needed

How lead extraction is done

Your procedure will be done by a cardiologist or cardiac surgeon who has received special training in this procedure. These are doctors who specialize in heart diseases. General anesthesia is used most often for this procedure, and a groin intravenous line is often inserted into the vein to allow for medication administration or other therapies that may be needed. The skin over the existing pulse generator is cut and the generator then removed. The leads are then isolated and prepped for removal. Since the leads may have formed attachments to the veins and the heart in your chest, special tools such as laser sheaths or mechanical sheaths are used to free up the leads from the surrounding chest structures. Once freed, the leads can then safely be removed.

Risks of lead extraction

All procedures have risks. Lead removal is a complex surgical procedure. The most serious risk is puncturing the heart or tearing a nearby blood vessel. Either of these can cause major bleeding in the chest. This may require blood transfusion or immediate open-heart surgery.

Other risks include:

  • Blood clot going into the lung (pulmonary embolism)

  • Infection of the pocket

  • Breaking of the lead

  • Pieces of a broken lead moving through blood vessels to lungs

  • Damage to a heart valve on the right side of the heart, causing it to leak

  • Complications from anesthesia

  • Fluid buildup around the heart or lungs

  • Bleeding under the skin

  • Swelling of the arm

  • Injury to the lung or collapsed lung (pneumothorax)

  • In rare cases, death

Your own risks may vary based on your age and sex, how many leads you need removed, and if your leads are have calcium buildup. Ask your healthcare provider which risks apply most to you.

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