Evaluation
People need lead extraction for many reasons. Sometimes a lead becomes damaged or infected, or is blocked by scar tissue. Sometimes a blood clot forms on a lead and obstructs blood flow. And in rare cases, a lead malfunctions or the product is recalled.
If your doctor thinks you need a lead extracted, you will first undergo certain tests. These may include:
- Blood tests
- Electrocardiogram (EKG) – a painless test that records your heart's electrical activity and can show whether your heart is beating abnormally
- Echocardiogram – an ultrasound in which sound waves produce images of the heart's anatomy and blood flow
- Venogram – an imaging test using a harmless injectable dye that shows up on X-rays to reveal the veins surrounding your heart
- CT scan – an imaging test in which a computer processes X-rays to create detailed images of your heart
Your doctor may want you to stop taking certain medications, such as aspirin or other blood thinners, a few days before the procedure.
Procedure
Patients having a lead extracted are admitted to the hospital. The procedure can take anywhere from two to six hours, depending on your specific situation. During the procedure, you'll be attended by a team that includes an electrophysiologist, anesthesiologist, nurses, technicians and a cardiac surgeon, who can intervene if complications arise.
You'll receive general anesthesia – meaning that you'll be completely asleep – during the procedure. The doctor will make a small incision to access a vein near your collarbone or in your groin area, and a sheath (a plastic, hollow tube) will be inserted into this blood vessel. Guided by X-ray images, the sheath is threaded to the place where the lead's tip is attached to the heart and then used to help free the lead from scar tissue binding it in place. Various other tools may be used to get rid of scar tissue and remove the lead and, if needed, replace it. Once the lead is free, both lead and sheath are removed through the blood vessel. The incision site will then be closed and bandaged. A chest x-ray will be done to review the status of your device and the placement of any newly inserted leads.
Recovery
You will recover in a post-op area, then be moved to a hospital bed, so we can monitor you overnight. If your lead was removed through a blood vessel in your groin, you will need to stay flat for several hours to prevent bleeding. Most patients can go home the next day. Before discharge, you'll get another chest x-ray and your doctor will talk to you about what to expect in the coming days and weeks.
Recovery will take at least a few days. You may have physical restrictions and not be able to drive for a few weeks. Avoid lifting anything heavier than 10 pounds for four to six weeks.
You will be scheduled for a one-week checkup, either in person or by video, so we can make sure the incision site is healing properly. A follow-up visit with your doctor will be scheduled for about one month post-op.
Risks
We have a high success rate with lead extractions. But all surgical procedures, especially those that are complex, have risks. While rare, potential complications include:
- Puncturing the heart or a surrounding blood vessel
- A blood clot lodging in the lungs, causing a pulmonary embolism, or traveling to the brain, causing a stroke
- Damage to one of the heart's valves, causing it to leak
- Complications from anesthesia
- Fluid accumulation around the heart or lungs
- Bleeding under the skin
- Swelling of the arm
- Infection
Certain circumstances make complications slightly more likely. These risk factors include being female, whether the leads are calcified and whether multiple leads are being removed. Your risks depend on these factors as well as your specific medical conditions. Be sure to understand your risks and discuss any concerns with your health care provider before undergoing lead extraction.
