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.
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 contract, or 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.
Over the years, the leads can become strongly attached to the walls of your veins and heart. This attachment can make lead extraction difficult.
What is Lead Extraction?
Although they are meant to remain in your body permanently, occasionally leads need to be removed.
Reasons for lead extraction include:
- Infection where the lead or device is implanted.
- Mechanical damage to the lead.
- Electrical malfunction of the lead.
- Recall of leads.
- An ICD or pacemaker device upgrade.
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.
Our Expertise in Lead Extraction
At UPMC Heart and Vascular Institute, our defibrillator and pacemaker lead extraction teams — all of whom have extensive experience with this demanding procedure — include:
- An electrophysiologist
- A cardiothoracic surgeon
- An anesthesiologist
- An imaging specialist
- Cardiac nurses
Lead extraction procedures are minimally invasive, however they carry risks. Complications could arise that require open surgery.
Our expertise in lead extraction is unique in western Pennsylvania because of:
- Our hybrid operating rooms 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 these procedures that we have been performing for several years.
- Our dedicated Cardiac Electrophysiology Program, which ranks as one of the largest in the United States.
What to Expect During Lead Extraction
Lead extraction takes from one to six hours to complete.
You will receive medication to make you sleep during the procedure.
Once 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. Larger catheters may require an incision in the groin area for continuous blood pressure monitoring, temporary pacing, and venous access.
- Inserts a sheath through the incision over the lead into a vein and guides it to the tip of the lead using the lead as a rail.
- May use a sheath that cuts through the scar tissue mechanically or a laser-powered sheath that cuts through the scar tissue by heating it.
When the sheath stops advancing, the electrophysiologist:
- Activates the laser, which vaporizes the scar tissue and frees the lead.
- Slowly advances the sheath until reaching the tip and then removes 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.
What to Expect 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.