Pacemaker and Defibrillator Lead Extraction

Lead extraction is a procedure to remove the wires that connect devices like pacemakers and implantable cardioverter defibrillators (ICDs) to the heart.

At Baystate Health, our cardiac surgeons and electrophysiologists work together to carefully remove outdated or malfunctioning wires and other leads. We use laser lead extraction and can often replace leads during the same minimally invasive procedure.

What Is Pacemaker and Defibrillator Lead Extraction?

Manufacturers design heart devices like pacemakers, ICDs, and biventricular pacemakers (cardiac resynchronization therapy or CRT) to last for many years. In some situations, the wires attached to these devices need to be removed because of:

• Damaged or malfunctioning lead: Wires can break, wear out, or stop working over time, or the device itself may malfunction.
• Infection: Bacteria can develop on the lead and cause an infection.
• Recall: Manufacturers may issue a safety recall that requires removal.
• Blocked vein: Scar tissue can clog the surrounding vein and block blood flow (occlusion).

Newer leads that are not trapped by scar tissue can often just be pulled out. We make a small incision over the device, usually located below your collarbone, to uncover the device and detach the lead.

Older leads require a minimally invasive lead extraction procedure. We use small incisions and a specialized laser to access your blood vessels and carefully remove the wires.

Why Choose Baystate Health for Pacemaker and Defibrillator Lead Extraction

Lead extraction requires careful precision and preparation. At Baystate Health, you’ll get advanced care through our:

• State-of-the-art hybrid operating rooms: While many hospitals perform lead extractions in an electrophysiology suite, we use a specialized hybrid operating room. This facility has the advanced imaging technology of a catheterization lab and the surgical capabilities of an open-heart operating suite.
• Procedures performed by heart surgeons: Our heart surgeons are involved at all stages and perform the lead extraction. This added expertise improves safety and allows our team to act quickly when blood vessels need repair.
• Proven safety track record: Our team-based approach and advanced facilities help us manage complex risks and provide an extra layer of safety. Working together helps us achieve excellent outcomes, including in emergencies.

Benefits and Risks of Pacemaker and Defibrillator Lead Extraction

Lead extraction can clear up infections, prevent future complications, and restore blood flow.

Your surgeon will help you understand the risks, which are rare but can include:

• Arrhythmia (irregular heartbeat)
• Bleeding or blood vessel damage
• Need for emergency open-heart surgery or a blood transfusion

What to Expect Before Lead Extraction

Your electrophysiologist (heart rhythm doctor) will determine if lead removal is needed. You may have a CT scan so we can see the exact location of your leads and analyze the extent of any scarring.

What Happens During Lead Extraction

On the day of your procedure, your nurse will review the procedure details and insert an IV for medications and anesthesia. You’ll also meet with your electrophysiologist, heart surgeon, and anesthesiologist before the procedure begins.

We’ll take you to an advanced operating room equipped with heart monitoring and imaging equipment. This room includes fluoroscopy, a type of X-ray that lets us see your blood vessels and heart in real time.

Your electrophysiologist and surgeon work together to perform the procedure. The electrophysiologist accesses the device and disconnects the lead, while your surgeon carefully removes it. This collaborative approach helps ensure the procedure is as safe and effective as possible.

During the procedure we:

• Insert an ultrasound probe in your esophagus. This device lets us monitor your heart throughout the procedure.
• Place a special catheter (tube) in a vein either under your collarbone or in your groin.
• Advance the catheter to the lead.
• Use a laser at the tip of the catheter to carefully remove the scar tissue around the lead, freeing up the wire.
• Remove the lead through the catheter.
• Insert new leads if needed.
• Close up the incisions.

Recovery After Lead Extraction

After the procedure, you’ll recover in our cardiac intensive care unit, where we carefully monitor you for potential complications. Most people go home the next day, after an evaluation, chest X-ray, and blood work.

You’ll have a follow-up appointment with your heart rhythm doctor about four to six weeks after the procedure.