What is a Lead?

A lead is a flexible wire that connects the pacemaker or implantable cardioverter defibrillator generator (battery) to the heart muscle.

What is a Lead Extraction? Why do we Need to Take them Out?

A lead extraction is the removal of one or more leads. Your doctor has determined that your lead(s) should be removed for one of the following reasons:

1. An infection at the site of the device and lead implant, in the blood stream or heart.
2. A damaged or broken lead is no longer necessary
3. The vein leading to the heart is blocked, and a channel is needed to insert a new wire
4. A different lead is needed to provide the right rhythm management
5. The lead is interfering with blood flow back to the heart.

How is a Lead Extraction Performed?

An incision is made in the upper chest over the existing pacemaker/ICD or wire. This is usually at the same site where the incision was made when the device was originally implanted. A special sheath (tube) is threaded over the lead that is attached to the heart and advanced into the vein following the lead right down to the tip. The sheath helps to free the lead of any scar tissue holding it in place and to help when pulling it out. The lead is then removed by pulling it out. Frequently the doctor will use a sheath that can deliver laser energy or that may contain a cutting tool to help cut away scar tissue from around the lead.

What should I Expect Before The Procedure?

You should ask your doctor which medications you should stop taking. You must not eat or drink anything after midnight the night before your lead extraction. If you must take medications, take them with only a sip of water. You may be admitted the day before or through the Pre-Admission Clinic on the day of the procedure.

What Should I Expect During The Procedure?

Your procedure takes place in the Operating Room. You will be required to wear a hospital gown. All jewelry, dentures, hearing aids, and glasses must be removed. A nurse will start an intravenous line that is used to administer medication to you during the procedure. An antibiotic will be given through your intravenous to help prevent or treat infections. You will be brought into the operating room suite where you will receive a general anesthetic.

Electrode wires will be attached to our chest and blood pressure cuff around your arm to monitor your heart rhythm and blood pressure throughout the procedure. The anesthetist may also decide to insert an arterial line into your wrist for monitoring your blood pressure continuously during the procedure.

You will see a large x-ray camera positioned in the room. This fluoroscopy machine helps the doctor to see the leads on the x-ray screen as they are being removed from your heart. A small clip called on oximeter monitor will be placed on your finger. It checks the oxygen level in your blood.

Defibrillator pads are sticky pads placed on the back and to one side of your chest. It allows the doctors and nurses to deliver energy to your heart if the rate is too fast or pace your heart if it is too slow.

You will be given a general anesthetic. After you are asleep, your chest and both groins will be cleansed with a special soap. Sterile drapes will be applied. They will cover you from your neck to your feet.

Will New leads be Implanted?

New leads may be implanted (placed in your heart) during this procedure or at a later date. This will depend on the reason your current leads are being removed. If they are being removed because of infection, your infection will be treated first. When the device is infected, the wound will not be closed, but will be left open with gauze to draw out the infection and are replaced once or twice a day to help the healing process. New leads will be implanted at a later date. Most patients will be in the hospital for 3-7 days. Your doctor will discuss this with you.

How Long Does The procedure Take?

The lead extraction procedure takes approximately two to four hours. After the procedure, you will be admitted into the hospital overnight. You will be taken to the Post Anesthetic Care Unit immediately after the procedure and then to your room. You will be placed on a special monitor called a telemetry monitor. Telemetry consists of a small box connected by wires to the outside of your chest with sticky electrode patches. This box allows your heart rhythm to be monitored so the health care team can observe your heart rate and rhythm in hospital.

What Tests or Procedures Will Be Done Before I Leave The Hospital?

You will have a chest x-ray in the morning after your procedure to check your lungs and the position of any new leads that may have been implanted. You will also have a blood sample taken to check your hemoglobin level. An echocardiogram (ultrasound of the heart) will also be done the morning after your procedure.

Are There Risks to Having a Lead Extraction?

A lead extraction is generally very safe. However, as with any invasive procedure, there are risks. Special precautions are taken to decrease the risks. The operating room is used for the extraction because there is a very small chance of bleeding due to a tear in the heart wall or a major blood vessel during the procedure that would need urgent repair by a cardiac surgeon.

Going Home

Your doctor and nurse will talk to you about activity, medications or any follow-up appointments before you leave the hospital. Expect there to be some bruising at the incision site as well as some redness and swelling. You should call the Pacemaker Clinic if you notice that:

1. The incision where the lead was extracted becomes increasingly red or drains pus-like fluid
2. The incision becomes very tender to touch
3. The incision is warm to the touch or swollen
4. You have a fever or chills

Summary

Step 1: You will receive an anesthetic and go off to sleep. If necessary, a temporary pacemaker will be%u2028put in through a vein in your neck or leg after you are asleep.

Step 2: The pacemaker or ICD battery and wires are exposed through an incision, similar to when%u2028the pacemaker or ICD was put in.

Step 3: The pacemaker or ICD battery is removed. A wire is passed into the inside of the pacemaker wire(s) to provide%u2028a firm hold on the entire wire.

Step 4: A laser sheath is passed over the pacemaker wire, tunneling along the wire to cut away scar tissue%u2028and allow the lead(s) to be removed.

Step 5: If a new pacemaker or ICD is needed, it is implanted and tested. In the case of infection, the wound is cleaned%u2028and left with packing and a dressing. If there is no infection, the pocket is closed.

If you have any questions or concerns, call the Pacemaker Clinic %u2028(Monday to Friday, 7:00AM to 4:30 PM)%u2028and ask to speak to Sue, Sally or Kelli at (519) 685-8500 Extension 35866.

Acknowledgements: Contributors to this information were: Dr. R. Yee M.D., Arrhythmia Service, LHSC (UC), Dr. A. Krahn MD, Arrhythmia Service, LHSC (UC), and various staff members.