Having Lead Extraction
Lead extraction is the removal of wires (leads) from your heart. The wires are part of an implanted cardiac device. This is a small device put into your chest that helps your heart keep a normal rhythm, such as a pacemaker or implanted defibrillator. If the leads that go from the generator (battery and computer) stop working or become infected, they will have to be removed and often times replaced.
What to tell your healthcare provider
Let your healthcare provider know what other medical conditions you currently have as well as any prior surgeries you have had, especially ones related to your heart and chest. Tell your healthcare provider about all the medicines you are taking especially those that are blood thinners and including any non-prescribed medicines or supplements.
Let your healthcare provider know if you are pregnant or think you may be pregnant. The imaging used during the procedure uses radiation. This may be a risk to a baby. Your healthcare provider may give you a pregnancy test to make sure you aren’t pregnant.
Tests before your procedure
You will have some tests before your procedure. These will include:
Electrocardiogram (ECG), to check your heart rhythm
Echocardiography (Echo), to look at heart anatomy and function
Chest X-ray to visualize the cardiac device and the wires in the heart
Venogram, to look at the veins around the device
Blood tests, to check your overall health as well as to prepare for a blood transfusion if needed
Getting ready for your procedure
Don't eat or drink anything after midnight on night before your procedure. Follow instructions about which medicines to take or stop before the procedure.
On the day of your procedure
Your procedure will be done either by a cardiologist or cardiac surgeon. These are doctors who specializes in heart diseases. He or she will work with a team of specialized nurses and technicians. The surgery can be done in several ways. Ask your doctor about the details of your surgery. The procedure may take as long as a few hours. In general, you can expect the following:
You will likely have general anesthesia, which includes medicine that allows you to sleep through the surgery as well as being placed on a breathing machine.. You won’t feel any pain during the surgery. In some cases, you may instead have medicine to help you relax.
A healthcare provider will watch your vital signs, like your heart rate and blood pressure, during the surgery.
If needed, skin in the area of surgery may be shaved and then cleaned.
Local numbing medicine will be given to prevent pain.
An incision will then be made over the site of the cardiac device. Scar tissue will be removed and the device removed.
The heart wires will then be identified for removal.
Using a variety of tools which may include laser or other mechanical sheaths, the leads will be freed from the blood vessels and heart so that they can be safely removed.
Your vital signs will be monitored carefully and ultrasound pictures of the heart may be taken through your esophagus. If complications occur, immediate open heart surgery may need to be done.
Depending on your situation, a new lead or leads may be replaced and the cardiac device replaced.
The skin will then be closed with suture and bandaged. You will then be transferred to the recovery room.
After your procedure
After surgery, you will be taken to a recovery room. Nurses will check your breathing, heart rate, and blood pressure. They will also watch your heart rhythm. You may be given pain medicine if you need it. You will need a follow-up chest X-ray to check your heart and lungs after the procedure. You’ll likely need to stay in the hospital at least one night.
Recovering at home
Follow all the instructions your healthcare provider gives you. Don't get the incision wet until your healthcare provider says it's OK. When you go home, go back to your normal activities when you feel able. Don't do any vigorous activity until your doctor says you are ready.
You may need to have stitches removed a week or so after the procedure. Make sure to keep all of your follow-up appointments.
When to call your healthcare provider
Call your healthcare provider right away if you have any of these:
Bleeding or fluid leaking from the incision that gets worse
Fever of 100.4°F (38.0°C) or higher, or as advised by your healthcare provider
April 27, 2018
Buch E, Boyle NG, Belott PH. Cardiology patient page: pacemaker and defibrillator lead extraction. Circulation. 2011;123:e378-e80., Garlitski AC. Cardiac implantable electronic device lead removal. UpToDate., Wilkoff BL, Love CJ, Byrd CL, et al. Transvenous lead extraction: Heart Rhythm Society expert consensus on facilities, training, indications, and patient management. Heart Rhythm. 2009;6:1085-1104.
Kang, Steven, MD,MMI board-certified, academically affiliated clinician,Snyder, Mandy, APRN,Turley, Ray, BSN, MSN