A pulse generator and a set of leads are the two major parts of implantable pacemakers and defibrillators. The pulse generator and the heart are connected by wires called leads.

The way the leads are made allows them to remain firmly attached to the heart. Even so, there are situations when it is important to remove leads. It's known as lead extraction. 

Why may a lead extraction be necessary?

Leads typically remain in the body permanently, but in some circumstances, you may need to have them removed. Lead extraction will only be done by your healthcare provider if the advantages exceed the hazards, Which include:

  • Device infection: That is the most prevalent reason for lead extraction. If any component of the pacemaker or ICD becomes infected, this is typically required. Without doing this, it is usually impossible to eliminate the infection. It is necessary to remove the pulse generator and all of the leads. Lead and generator extraction would also be necessary for a heart valve infection.
  • Broken leads: This is yet another important factor in lead extraction. Broken leads don't always need to be removed. Sometimes a surgeon will insert a new lead next to the broken lead in the heart. It's not always viable to do this due to space limitations. Even when there is room for a new lead, people occasionally choose to have their existing lead removed. This may be the case for a young person who will likely require further leads in the future. This person could decide to have the leads removed as it is more challenging to do so afterward.
  • There are a number of other medically approved reasons for lead extraction, which are less common. The following are examples:

                a) Dangerous or malfunctioning leads (like a protruding wire)

                b) Recall on a specific pacemaker or ICD lead

                c) Clot formation on a lead that obstructs a vein

                d) Retained lead triggering abnormal heart rhythms or other complications

How is lead extraction performed?

Lead extraction can be done in one of two ways:

      1. Subclavian Approach

  • It is the most frequently used approach. The leads are removed through an incision in the upper chest over the subclavian vein.

      2. Femoral Approach

  • When the subclavian route is not possible, the femoral technique is employed.

The procedure takes between 2 and 6 hours. The extraction will be carried out by a cardiologist and a specialized group of nurses and technicians. During the procedure:

  1. A tiny puncture in the groin over the femoral vein is used to remove the leads.
  2. A special sheath is placed in the vein. This sheath is threaded over the lead and guided to the tip of the lead.
  3. A laser light or mechanical drill-like tip can be attached to the sheath to break the scar tissue.
  4. The leads and sheath will be removed through the blood vessel by your medical personnel.
  5. They might even place new leads at this time in select conditions.

In the hospital after the procedure:

  • You'll stay in a recovery room for a while.
  • Your vital signs, including your breathing and heart rate, will be observed by the team. They will also keep an eye on your heartbeat.
  • If a vein in your leg was used for the extraction, you will need to lie flat for many hours after the procedure. You should not bend your legs. This will help prevent bleeding.
  • You can ask your health care provider to give you pain medicine if you are experiencing severe pain.
  • Although the length of stay varies, you should plan to stay at least one night.
  • You will have a follow-up chest X-ray to check your lungs, heart and the position of new leads if new leads are placed on the next morning after the procedure.
  • You will need someone to drive you home after the procedure. 

Watch this video to learn how the procedure is done (Facility specific Video to be added)

What are the risks associated with lead extraction?

In most cases, lead removal is successful, but it is a challenging surgical process. As a result, it carries some genuine risks that will be thoroughly discussed with you. The heart could be punctured or a nearby blood artery could be torn. This could necessitate a blood transfusion or emergency open-heart surgery.

Other possible problems include:

  1. Blood clot lodging in the lung (pulmonary embolism)
  2. Stroke
  3. Damage to the heart valve on the right side of the heart, causing it to leak
  4. Complications from anesthesia
  5. Fluid accumulation around the heart or lung
  6. Bleeding under the skin
  7. Swelling of the limb
  8. Infection

Complications are a little more likely due to some circumstances. They include being female, being younger, having calcified leads, or needing to remove multiple leads. Your risk will be determined by your underlying medical conditions. Before having your lead extracted, be sure to talk to your doctor about your worries.

Reference - Lead Extraction. (n.d.). Retrieved from https://my.clevelandclinic.org/health/treatments/17165-lead-extraction