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Lead Extraction at Drexel Cardiology

Pacemaker / Implantable Cardioverter Defibrillator

U.S. surgeons implant over 400,000 cardiac devices in patients every year. Worldwide, more than 3 million people use a pacemaker or an implantable cardioverter defibrillator (ICD) to treat heart rhythm disorders. Implanting the device is a simple procedure that, over the years, has become increasingly common, especially with people over the age of 65.

These devices, which are designed to help the heart maintain a healthy rhythm, consist of two parts. They have a pulse generator, which contains electric circuits and a battery, and they also include a set of wires (commonly called leads), which run between the pulse generator and the heart.

Most devices need to have the battery replaced every 5 to 10 years. Like the implantation, this is a simple procedure. The leads, on the other hand, attach to the heart muscle and ideally don't need to be changed, but occasionally situations arise when they need to be extracted.

Reasons for Lead Extraction

When your leads aren't working properly, they need to be extracted. There are a few different reasons why a lead may not work, including:

  • Infection
  • Damage to the inside or outside of the lead
  • Large amounts of scar tissue forming around the tip of the lead, causing it to need more energy than your pacemaker or ICD can handle
  • Blockage of the vein by a clot or scar tissue

How to Prepare for Your Lead Extraction Procedure

Before your procedure be sure to do the following:

  • Ask your doctor if you need to stop taking any medications. If so, you'll likely need to stop one to five days before your test. If you have diabetes, ask your doctor how you should adjust your medication.
  • Refrain from eating and drinking anything after midnight the evening before your test. If you need to take medications, drink only a sip of water to get it down.
  • You'll need to stay in the hospital overnight, so wear comfortable clothes and bring general toiletries. You'll also want to arrange for a family member or friend to drive you home.

What to Expect During the Procedure

The lead extraction procedure usually takes between 2 to 6 hours, and patients are usually admitted to the hospital for a minimum of 1 night. If needed, new cardiac devices and leads may be implanted at the same time as the lead extraction or on a different day.

Other things to expect during the procedure include:

  • Once in a hospital gown and on a bed, the nurse will start an intravenous (IV) line in your arm so that medications and fluids can be administered during the procedure.
  • You'll likely be given general anesthesia, which will cause you to "sleep" through the procedure. If you are not given general anesthesia you will receive medication through your IV that will make you drowsy throughout the procedure.
  • There are two approaches to lead extraction:
    • Subclavian: This is the most frequently used approach. Leads are extracted through an incision in the upper chest over the subclavian vein.
    • Femoral: This is used when the subclavian approach is not possible. The leads are removed through a small puncture in the groin over the femoral vein.
  • You may feel a pulling as the leads are removed, but you shouldn't feel pain.
  • A special sheath (tube) is placed in the vein and threaded over the lead and guided to the tip where it attached to the heart. A laser light or mechanical drill-like tip can often be attached to the sheath to help break up scar tissue as the lead is removed.
  • Several devices will be used to monitor your condition throughout the procedure.
  • The morning after the extraction, you will have a chest X-ray to check your lungs and the position of any new leads that were implanted.

Nationally Recognized Cardiac Electrophysiologists

Drexel Cardiology's electrophysiologists are nationally recognized as experts in lead extraction and are part of a small number of medical centers to offer the procedure. Dr. Kutalek, specifically, places in the top tier in the U.S. for the number of lead extractions successfully performed. He also serves as a consultant for device companies for future lead technology.

If you're experiencing problems with your cardiac device, we encourage you to schedule an appointment with one of our cardiologists today.

The information on these pages is provided for general information only and should not be used for diagnosis or treatment, or as a substitute for consultation with a physician or health care professional. If you have specific questions or concerns about your health, you should consult your health care professional.

The images being used are for illustrative purposes only; any person depicted is a model.

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