Pacemaker and Defibrillator Lead Extraction

Implantable devices such as pacemakers and cardioverter defibrillators (ICDs) are used to treat arrythmias. These devices have wires called leads that carry electrical current from the device to your heart. Although the leads are meant to remain in your body permanently, they may need to be removed.

During pacemaker or defibrillator lead extraction, your UPMC electrophysiologist removes the leads. Our defibrillator and pacemaker lead extraction teams include multiple cardiovascular specialists who have extensive experience performing this complex minimally invasive procedure.

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What Is Pacemaker and Defibrillator Lead Extraction?

Surgeons may use an implantable device — either a cardioverter defibrillator (ICD) or pacemaker — to treat heart rhythm problems (arrhythmias).

• ICDs are for people with dangerous heart rhythms, such as ventricular tachycardia, and deliver electric shocks to restore a normal heart rhythm.
• Pacemakers increase your heart rate when it beats too slowly.

Although they perform different functions, both devices consist of a pulse generator — a small metal box that contains a battery and electronic circuits.

One end of the wire leads connects to the pulse generator — typically run through a vein to the right side of your heart — and delivers a small amount of electric current when needed. The electricity causes your heart to beat.

To ensure the leads stay in the right place in your heart, the surgeon performing the implantation attaches them to your heart using very small screws or tines. In response — as part of the healing process — scar tissue forms on the leads and at the tip where it connects to your heart.

Although they are meant to remain in your body permanently, occasionally pacemaker/defibrillator leads need to be removed. In pacemaker or defibrillator lead extraction, your UPMC electrophysiologist removes the leads — the wires that carry electrical current from your implantable device to your heart — through a small incision during a minimally invasive procedure.

Why Would I Need Pacemaker and Defibrillator Lead Extraction?

Reasons for lead extraction include:

• An ICD or pacemaker device upgrade.
• Electrical malfunction of the lead.
• Infection where the lead or device is implanted.
• Mechanical damage to the lead.
• Recall of leads.

Who’s a candidate for pacemaker or defibrillator lead extraction?

Because lead extraction is a complex procedure that carries some surgical risk, your provider will let you know if you are a candidate for lead extraction.

You may be a candidate for lead extraction if you are upgrading your implantable cardiac device, develop an infection, have a problem with your leads, or your leads are recalled by the manufacturer.

What Are the Risks and Complications of Pacemaker and Defibrillator Lead Extraction?

Lead extraction procedures are minimally invasive. However, they still carry risks. Complications could arise that require open surgery. Potential complications include:

• Heart or blood vessel damage.
• Blood clots that cause stroke or pulmonary embolism.
• Fluid buildup in the heart or lungs.
• Infection.

How risky is lead extraction?

Lead extraction is a safe procedure when performed by an experienced team of experts. However, because the leads often become attached to your vein walls and heart, lead extraction carries risks and requires more skill than it does to implant them. Removing the attached leads can damage the lead, veins, or heart.

What Should I Expect from Pacemaker and Defibrillator Lead Extraction?

Before: How to prepare for pacemaker and defibrillator lead extraction

Your doctor will explain the lead extraction procedure to you and give you a chance to ask questions. To prepare for a lead extraction, you should:

• Tell your doctor if you are sensitive or allergic to any medications, iodine, latex, tape, or anesthetic agents (local and general).
• Tell your doctor about all medications (prescription and over-the-counter) and herbal or other supplements you are taking.
• Tell your doctor if you have heart valve disease, as you may need to receive an antibiotic before the procedure. 
• Tell your doctor if you have a history of bleeding disorders or if you are taking any blood-thinning medications, aspirin, or other medications that affect blood clotting. It may be necessary to stop some of the medications prior to the procedure.
• Fast for a certain period of time prior to the procedure. Your doctor will tell you how long to fast (usually overnight).
• Have any tests that your doctor recommends. For example, your doctor may request a blood test prior to the procedure to determine how long it takes your blood to clot.

On the day of your lead extraction procedure, be sure to bring your photo ID and health insurance card(s). Leave valuables such as cash and jewelry at home.

You will need to stay in the hospital overnight after your procedure. You should bring toiletries, a robe, slippers, a cell phone and charger, medications, and a change of clothes. If you have an infection, you may need to stay in the hospital until the infection is gone. You should arrange for someone to drive you home from the hospital after you are discharged.

How long does pacemaker and defibrillator lead extraction take?

Lead extraction takes between 1 to 6 hours to complete. You will need to stay in the hospital for at least one night after your procedure.

During your lead extraction procedure

You will receive medication through an IV to make you sleep during the procedure. After you are asleep, your UPMC electrophysiologist will:

• Numb the incision site and then make a small incision at the site of the implanted device — typically in the left or right shoulder area. You may need an incision in your groin area for continuous blood pressure monitoring, temporary heart rhythm pacing, and access to your veins.
• Insert a tube called a sheath through the incision. The sheath will go over the lead into your vein.
• Guide the sheath into your body to the tip of the lead using the lead as a rail.
• Use a sheath that cuts through the scar tissue mechanically or a laser-powered sheath that cuts through the scar tissue by heating it.

What is the extraction method for a lead?

When the sheath stops advancing, the electrophysiologist:

• Activates the laser or mechanical device to release scar tissue and free the lead.
• Slowly advances the sheath until reaching the tip before removing the lead.
• May implant new leads following the extraction, depending on the reason for removal. If it’s because of an infection, you will need treatment for the infection before receiving new leads.

Recovery after lead extraction

Because lead extraction typically involves only a small incision, you may be able to go home the day after the procedure. If you have an infection, you may need to remain in the hospital or at a skilled nursing facility until the infection is gone. 

Your doctor will let you know when you can resume everyday activities and will schedule a follow-up appointment for you.

When to call your doctor about complications

You should call your doctor if you are experiencing any unusual symptoms, including:

• A fever of more than 100.0°F.
• Burning or pain in your chest.
• Difficulty breathing.
• Difficulty swallowing, throat pain, or bloody cough.
• New or increasing shortness of breath.
• Pain, redness, bleeding, drainage, or increased swelling at the incision site.
• Rapid or pounding heartbeat.
• Redness or rash on your chest or back.

What’s the prognosis of lead extraction?

After lead extraction, many people receive new leads or a new device and can resume normal activities.

What’s the success rate of lead extraction?

When performed by a skilled and experienced team, lead extraction success rates may exceed 90 percent. However, your doctor will discuss your condition and expected success rate with you before your procedure.

Why Choose UPMC for Lead Extraction?

At UPMC, our defibrillator and pacemaker lead extraction teams — all of whom have extensive experience with this complex procedure — include:

• An anesthesiologist.
• A cardiac imaging specialist.
• A cardiothoracic surgeon.
• An electrophysiologist.
• Cardiac nurses.

Our expertise in lead extraction is unique in Pennsylvania due to:

• Our hybrid operating rooms are equipped for minimally invasive procedures and open surgery. If complications arise during lead extraction and a patient requires open-heart surgery, our hybrid operating rooms convert almost immediately from a catheterization laboratory to a surgical suite.
• The high volume of lead extraction procedures we perform.
• Our dedicated cardiac electrophysiology experts, who are at the forefront of the latest advances in lead extraction. 

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By UPMC Editorial Staff. Last reviewed on 2024-10-01.