Pacemaker Lead Extraction
What is a Pacemaker Lead Extraction?
Pacemaker lead extraction is highly advanced procedure to remove an existing pacemaker lead from the heart.
The pacemaker leads run from the pulse generator of the Pacemaker/ICD on the chest, into the vein beneath the clavicle bone and down into the heart. Pacing leads that have been inside the body for many years become very well stuck down and attached to both the blood vessel wall and to the heart. Removing these leads is a challenging and potentially dangerous procedure.
Due to these challenges, only a Electrophysiology Cardiologist with significant specialised experience and skills in lead extraction will be called upon to perform this procedure. The Electrophysiology Cardiologist opens the area where the leads are attached to the pulse generator and disconnects the leads. Laser or mechanical sheaths are then placed over the leads to free them from the body, allowing them to be removed safely from the body.
Why might I need a lead extraction?
Leads usually stay in the body permanently, but you may need to have them removed in certain cases. The most common reasons for extraction are:
- Device infection, which is the most common reason for removal,
- Infection of a heart valve
- Broken leads
How do I Prepare?
- Your doctor will advise you if any medication needs to be ceased prior to the procedure.
- You will be required to fast for 6 hours prior to the procedure.
- Some patients may be required to have their chest shaved.
- You will have a cannula inserted into your arm vein and connected to a drip.
- You will be given preoperative IV antibiotic.
- You may have some tests before your procedure. These might include:
- Electrocardiogram (ECG), to analyse the heart rhythm
- Echocardiography (Echo), to evaluate heart anatomy and function
- Venogram, to evaluate vein anatomy surrounding the device
- Blood tests, to establish a baseline before the procedure
What Should I Expect?
During the Procedure
- At the beginning of the procedure you will be given an anaesthetic.
- An incision is made in the skin over your cardiac device. The leads are disconnected from the cardiac device. A variety of methods and tools may be used in order to safely remove the pacing leads from the heart.
- A new permanent pacing system or a temporary pacing system may be inserted during the procedure.
- The skin incision is closed in several layers using sutures and a sterile waterproof dressing will be applied over the incision.
- The procedure can take 2 to 6 hours.
After the Procedure:
- You will most likely need to stay in hospital a minimum of one night after the procedure.
- You will have continuous ECG monitoring while you are in hospital.
- You may need some pain relief medication. Pain is usually mild and is usually controlled with paracetamol.
- Most people will be discharged from hospital the following day.
- You will receive some information about how long to keep your waterproof dressing on over your device implant site.
- You will be given a follow up plan with your Doctor.