Laser Lead Extraction

Introduction

A lead is a flexible wire that connects the pacemaker or implantable cardioverter defibrillator generator (battery) to the heart muscle. A lead extraction is the removal of one or more leads. Your doctor has determined that your lead(s) should be removed for one of the following reasons:

Damage to the lead
The lead requires more energy to function than the device (pacemaker or ICD) is able to deliver
An infection at the site of the device and lead implant
The lead is interfering with blood flow back to the heart

How is a Lead Extraction Performed?

An incision is made in the upper chest over the existing pacemaker or wire. This is usually at the same site where the incision was made when the device (pacemaker or ICD) was originally implanted. A special sheath (tube) is placed in the vein, threaded over the lead that is attached to the heart and then guided to the tip. The sheath helps to free the lead of any scar tissue holding it in place and to help
when pulling it out. The lead is then removed by pulling it out through the
sheath. Frequently the doctor will use a sheath attached to a laser to remove scar tissue from around the lead where it is attached to the heart muscle or vein.

Risk Factors

A lead extraction is generally very safe. However, as with any invasive
procedure, there are risks. Special precautions are taken to decrease the risks. The operating room is used for the extraction because there is a very small chance of bleeding due to a tear in the heart wall or a major blood vessel during the procedure that would need urgent repair by a cardiac surgeon. Sometimes patients are put on blood thinners after the procedure to prevent a clot.

What to Expect Before the Lead Extraction

You will be told which medications you should stop taking. You must not eat or drink anything after midnight the night before your lead extraction. If you must take medications, take them with only a sip of water. You may be admitted the day before or through the Pre-Admission Clinic on the day of the procedure.

What to Expect During the Lead Extraction

Your procedure takes place in the Operating Room. You will be required to wear a hospital gown. All jewelry, dentures, hearing aids, and glasses must be removed. A nurse will start an intravenous that is used to administer medication to you during the procedure. An antibiotic will be given through your intravenous to help prevent or treat infections. You will be brought into the operating room suite where you will receive an anaesthetic.

You will be monitored at all times. An electrocardiogram (heart monitor) will be attached to your chest. This provides a picture of the electrical impulses traveling through your heart. You will also be attached to a blood pressure monitor by a cuff on your arm. This checks your blood pressure during the procedure. You may also have an arterial line inserted into your wrist for monitoring your blood pressure continuously during the procedure.

You will see a large x-ray camera positioned in the room. This fluoroscopy machine helps the doctor to see the leads on the x-ray screen as they are being removed from your heart. A small clip called on oximeter monitor will be placed on your finger. It checks the level of oxygen in your blood. Defibrillator pads are sticky pads placed on the back and to one side of your chest. It allows the doctors and nurses to deliver energy to your heart if the rate is too fast or pace your heart if it is too slow.

After you are asleep, your chest and both groins will be cleansed with a special soap. Sterile drapes will be applied. They will cover you from your neck to your feet.

Will New Leads be Implanted?

The procedure takes approximately two to four hours. After the procedure, you will be admitted to the hospital overnight. You will be taken to the Post Anaesthetic Care Unit after the procedure and then to your room. You will be placed on a special monitor called a telemetry monitor. Telemetry consists of a small box connected by wires to the outside of your chest with sticky electrode patches. This box allows your heart rhythm to be displayed on a monitor so the nurses can observe your heart rate and rhythm.

What to Expect After the Lead Extraction

The procedure takes approximately two to four hours. After the procedure, you will be admitted to the hospital overnight. You will be taken to the Post Anaesthetic Care Unit after the procedure and then to your room. You will be placed on a special monitor called a telemetry monitor. Telemetry consists of a small box connected by wires to the outside of your chest with sticky electrode patches. This box allows your heart rhythm to be displayed on a monitor so the nurses can observe your heart rate and rhythm.

You will have a chest x-ray in the morning after your procedure to check
your lungs and the position of any new leads that may have been implanted. You will also have a blood sample taken to check your hemoglobin level. An echocardiogram, similar to an ultrasound of the heart will also be done in the morning after your procedure.

Going Home

Your doctor and nurse will talk to you about activity, medications or any follow-up appointments before you leave the hospital. There will be some bruising at the incision site as well as some redness and swelling. You should call the Pacemaker Clinic if you notice that:

The incision where the lead was extracted becomes increasingly red or drains pus-like fluid.
The incision becomes very tender to touch.
The incision is warm to the touch or swollen.
You have a fever or chills.