Pacemaker/Defibrillator Lead Extraction
Cardiac pacemakers and defibrillators – usually implanted under the skin in the upper chest area – supply vital electrical impulses to the heart to correct arrhythmias and maintain a normal heart rhythm. “Leads” are the wires from either device that deliver the impulses to the heart. They are threaded through a vein and attached to heart muscle. A lead extraction procedure is performed when the leads have to be removed or replaced, usually due to lead age or damage, formation of too much scar tissue where the lead is attached to the heart, or infection of that area.
Extraction procedures involve administering a general anesthesia to the patient. The most used extraction takes place through the subclavian vein, entered through an incision in the upper chest. The electrophysiologist then threads a hollow, tube-like plastic sheath over the lead and guides it in to where the tip of the lead connects to heart tissue. The sheath holds the heart muscle away while the lead is gently pulled away. In many cases, the sheath will have a laser on its tip to help burn away excess scar tissue, making it easier to extract the lead. At this point, new leads may be implanted to replace the old leads. When entering the subclavian vein is not possible, the same procedure can also be performed through the femoral vein in the groin.
Following the procedure, the patient will usually stay overnight in the hospital to be closely watched. X-rays will check for placement of newly implanted leads. Heart rhythms will be monitored through telemetry and a Holter monitor to make sure the heart is beating properly and that new leads from a pacemaker or defibrillator are delivering impulses to ensure a normal heart rhythm. Complications from the procedure are extremely unlikely but could include puncture and bleeding in the vein and heart tissue.
MDCA cardiologists are highly specialized and experienced in performing lead extraction procedures, as well as in all areas of pacemaker and defibrillator implantation and maintenance.