The leads are wires that deliver energy from a pacemaker or implantable cardioverter defibrillator (ICD) to the heart muscle. Extraction of lead is the removal of one or more leads from inside the heart.
The procedure is needed when leads are not working properly due to damage to the inside (called a fracture) or outside of the lead, infection at the site of the device and lead implant or large amounts of scar tissue form at the tip of the lead, causing it to need more energy to function than your pacemaker or ICD can deliver (called "exit block").
Before the procedure, the doctor will give patient instructions about taking or not taking some medications. The patient must not eat or drink anything after midnight the evening before the procedure and if he/she must take medications, the patient must drink it only with a sip of water. Also, the patient must arrange for a companion to drive him/her home next day of the procedure.
During the procedure, the patient’s chest and groin area will be shaved if it is necessary and cleansed with an antiseptic solution. The patient will be given a drug through IV to make him/her sleep throughout most of the procedure.
The procedure can be performed through one of two sites:
- Subclavian vein (in the upper chest) which is most frequently used
- Femoral vein (in the groin) which is used when the subclavian approach cannot be performed
The doctor will numb the site and a sheath (plastic, hollow tube) is placed in the vein and guided to the tip of the lead (where the lead attaches to the heart) to help to hold the heart muscle in place while removing the lead.
With a laser or special electrosurgical sheath, the doctor will deliver energy to remove scar tissue from the lead and the lead will be removed. New leads can be placed in the patient’s heart then or during the new procedure, which depends on the reason the current leads are being removed. The whole procedure takes about two to six hours to perform.
After the procedure, the patient will be admitted to the hospital overnight and placed on a special monitor called telemetry that allows heart rhythm to be displayed on monitors in the nursing unit.
A Holter monitor will be used to record heart rhythm for a few hours if the patient had new leads and a pacemaker implanted. Next morning, the patient will have a chest X-ray to check his/her lungs and the position of any new leads that may have been implanted.
The doctor and nurse will give patient information’s about his/her activity, medications or any follow-up appointments.