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LEAD EXTRACTION

A Simple Explanation

The procedure performed to remove the leads of the Pacemaker that was implanted in the patient’s body.

What is Lead Extraction?

The lead is a special wire that is used to deliver energy from the pacemaker or Implantable Cardioverter Defibrillator (ICD) to the heart muscle.

Lead Extraction is the procedure to extract one or more of the leads. The leads that were placed outside the heart during a open-heart surgery cannot be removed.

Why do we need Lead Extraction?

The lead of the pacemaker are extracted for the following reasons:

  • Damage to the lead either external or internal, called a ‘fracture’.
  • Due to the presence of large amounts of scar tissue at the lead’s tip, the lead will need more energy from the pacemaker to function, sometimes exceeding the pacemaker’s capacity. This is called ‘Exit Block’.
  • The failure of the mechanical lead that can be fatal to the patient, like a protruding wire.
  • When the lead doesn’t work properly, for instance, when the metal wire or the surrounding insulation breaks. The broken lead is sometimes abandoned in the heart, placing a new lead alongside.
  • Device Infection is a common reason for lead extraction. Even for a small infection, it is not possible to remove the complete infection so removing the complete hardware is a better solution, including the pulse generator from the chest as well as all the leads from the veins and the heart.

How is it done?

Lead extraction, being a minor surgical procedure is performed in the cardiac catheterization laboratory.

There are two approaches to perform this procedure:

Sub-Clavian Approach (Upper Chest)

Here, the leads are extracted through an incision in the upper chest over the Sub-Clavian vein.

Femoral Approach (Groin)

This is performed when the Sub-Clavian approach is not possible. For this, a small puncture is made over the Femoral Vein, in the groin.

The Actual Procedure

Once the incision or puncture is done, depending on the approach, the doctor will numb the site. A special sheath (tube) is inserted in the vein and guided to where the lead connects to the heart. This sheath helps in holding the heart muscle in place while the leads are removed.

A Laser or a special sheath is usually used to help remove the scar tissue, by delivering energy to the tip of the sheath to vaporize the scar tissue. This will, in turn, help in cutting the lead from its attachments and allowing the smooth removal of the leads.

The new leads will either be replaced then or at a later date depending on the reason for the lead extraction.

Once the leads are removed, the doctor will remove the sheaths.

Patient’s Role

Pre-Procedure

The patient is not allowed to eat or drink 8 hours before the procedure. The patient will have to consult the doctor whether to continue taking the medications.

Post-Procedure

  • The patient will be admitted in the hospital for observation, usually done using the Telemetry, to monitor the heart’s rhythm.
  • If the Femoral approach is used, the patient has to lie flat for sometime.
  • A chest X-ray will be done to check the lungs and other areas where the leads were put in.
  • The doctor will discuss the activities to be done and medications to be taken after the procedure.
  • The doctor will also set up Follow-up appointments after the patient leaves the hospital.

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Billroth Hospitals,
43, Lakshmi Talkies Road, Shenoy Nagar,
Chennai-30.

+91-44-42921777

+91-7299404040

admin@billrothhospitals.com

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