A pacemaker or implantable cardioverter defibrillator (ICD) delivers energy to your heart muscle through wires called leads. A lead extraction is when one or more of those are removed.
Leads put outside the heart during open heart surgery can’t be taken out this way.
When Is a Lead Extraction Needed?
It can be necessary because of:
Damage to the inside or outside of the lead. Your doctor may call this a “fracture.”
Large amounts of scar tissue at the tip of the lead. When this happens, the lead needs more energy than your pacemaker or ICD can give. Your doctor may call this “exit block.”
Infection at the site of the device and where the lead is implanted.
How Do I Prepare?
Ask your doctor what medicines you can take. Make sure your doctor is aware of all the over-the-counter meds and supplements you’re taking. They may ask you to stop taking some drugs for up to 5 days before your procedure. Ask how you should adjust your meds if you have diabetes.
Don’t eat or drink anything after midnight the evening before your procedure. If you must take medicines, drink only a sip of water.
When you come to the hospital, wear comfortable clothes. You’ll change into a hospital gown for the extraction. Leave jewelry and other valuables at home.
You’ll need to stay in the hospital overnight. Bring things with you that will make your stay more comfortable. Fox example, a:
Make plans for someone to drive you home when you’re able to leave.
What to Expect
The whole thing takes from 2 to 6 hours.
You’ll lie on a bed, and the nurse will start an intravenous (IV) line in your arm so medicines and fluids can be given while it’s going on.
Your chest and groin area will be shaved and cleansed with antiseptic. Sterile drapes will cover you from your neck to your feet to make sure you don’t get infected. It’s important that you keep your arms and hands at your sides so the drapes don’t move around. A soft strap will be put across your waist and arms to keep your hands from touching the sterile area.
The nurse will connect you to several monitors.
You may feel nervous. You’ll be given a drug through your IV that will make you sleep through most of the procedure. Your doctor and nurse will be with you. Let them know if you’re uncomfortable or need anything.
The lead extraction will be done through one of two places:
The subclavian vein (in the upper chest) is most common. A cut is made in the upper chest over the subclavian vein.
The femoral vein (in the groin) is used when the subclavian approach can’t be done. A small puncture (instead of a cut) is made over the vein.
The doctor will numb the site. A sheath (a plastic, hollow tube) is put in the vein and guided to where the lead connects to the heart. The sheath helps hold the heart muscle in place while the lead is removed.
A laser or special sheath delivers energy to remove scar tissue from the lead. You’ll be in a light sleep during this part. You may feel pulling as the leads are removed, but you shouldn’t feel pain.
New leads might be placed in your heart during the procedure, or at a later date. This depends on why your current leads are being taken out. Talk about this with your doctor.
After It’s Done
The doctor will remove the sheath.
You’ll be admitted to the hospital overnight. They’ll put you on a special monitor called telemetry that allows your heart’s rhythm to be displayed on monitors in the nursing unit.
You’ll need to lie flat in bed for several hours after the procedure if the femoral approach was used.
A chest X-ray will be taken the morning after to check your lungs and the areas where any new leads were put in.
Your doctor and nurse will talk to you about what activities you can do, medications you’ll take, or follow-up appointments you’ll need before you leave the hospital.