Lead Extraction
 
 

Lead Extraction

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Lead Extraction

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 rhythm.

Understanding implanted cardiac devices

Many people have implanted cardiac devices. These devices include pacemakers and implantable cardioverter defibrillators (ICDs). 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.

  • 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 is lead extraction done?

The most common needs for lead extraction are:

  • Infection of any part of the cardiac device

  • Infection of a heart valve

  • Broken leads

When any of these happen, the pulse generator and all the leads must be removed.

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

  • Dangerous or malfunctioning leads (such as a protruding wire)

  • Recall on a certain type of pacemaker or ICD lead

  • Blood clot on a lead that blocks a vein

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

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)

  • Stroke

  • 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

  • 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 health care provider which risks apply most to you.

Getting ready for your procedure

You may need to not eat or drink before midnight of the day of your procedure. Follow instructions about what medicines to take before the procedure. Don’t stop taking any medicine unless your health care provider tells you to do so.

You may have some tests before your procedure. These might include:

  • Electrocardiogram (EKG), to check your heart rhythm

  • Echocardiography (Echo), to  look at heart anatomy and function

  • Venogram, to look at the veins around the device

  • Blood tests, to check your overall health

Let your health care provider know if you are pregnant or think you may be pregnant. The imaging used during the procedure uses radiation. This may be a risk to a baby. Your health care provider may give you a pregnancy test to make sure you aren’t pregnant.

On the day of your procedure

Your procedure will be done by a cardiologist. This is a doctor who specializes in heart diseases. He or she will work with a team of specialized nurses and technicians. The surgery can be done in several ways. Ask your doctor about the details of your surgery. The procedure takes 2 to 6 hours. In general, you can expect the following:

  • You will likely have general anesthesia, medicine that allows you to sleep through the surgery. You won’t feel any pain during the surgery. In some cases, you may instead have medicine to help you relax.

  • A health care provider will watch your vital signs, like your heart rate and blood pressure, during the surgery.

  • If needed, skin in the area of surgery may be shaved.

  • A cut (incision) is made in your shoulder or groin.

  • A small hole in a blood vessel is made. A tapered tube called a sheath is put through this hole.

  • The sheath is then guided to the correct place in your heart.

  • Next, the leads are removed from the heart using the sheath. A variety of methods and tools can be used, depending on your specific situation.

  • The team will carefully watch you during the procedure. If complications occur, you may need to have immediate open-heart surgery.

  • The team will remove the leads and sheath through the blood vessel. In some cases, they also place new leads at this time.

  • The team will close and bandage the site where they inserted the sheath.

After your procedure

After surgery, you will be taken to a recovery room. Nurses will check your breathing, heart rate, and blood pressure. They will also watch your heart rhythm. You may be given pain medicine if you need it. If the incision was made in a vein in your leg, you will need to lie flat for several hours after the procedure. You should not bend your legs. This will help prevent bleeding. You will need a follow-up chest X-ray to check your heart and lungs after the procedure. You’ll likely need to stay in the hospital 1 or more nights.

Recovering at home

Follow all the instructions your health care provider gives you. When you go home, go back to your normal activity when you feel able. Avoid vigorous activity until your doctor says you are ready.

Follow-up care

You may need to have stitches (sutures) removed a week or so after the procedure. Make sure to keep all of your follow-up appointments.

When to call your health care provider

Call your health care provider right away if you have any of these:

  • Swelling that gets worse

  • Bleeding or fluid leaking from the incision that gets works

  • Fever of 100.4°f (38.0°c) or higher