Lead extraction

lead extraction

by zawodniak2 - 2018-01-07 23:38:45

Make sure you have the procedure done at a facility which does lots of extractions and the doctor does at least 100 per year.  Also they should have a cardiac surgeon readily available in the unlikely event of a complication.  With the laser technique, this procedure has become very safe.

                               Rodger

Me Too!

by Janey L - 2018-01-09 02:41:09

Hi. I know exactly how you feel as I was told yesterday I have to have my pacemaker leads extracted and pacemaker removed - and have ICD put in. As soon as I heard the words "lead extraction" I knew this was not good!

My EP has a LOT of experience but apparently he will not be doing the lead extraction, they leave that to a much more experienced EP in the hospital (I am in the UK). I trust my EP 100% so I was disappointed to hear I will not be in his hands, but equally pleased that I will be in the best hands for the procedure.

All I know is I will be having it done under general anaesthetic so I won't know what is going on. I had 3 ablations and my pacemaker put in while awake.

I was told there is a risk of bleeding in the heart, even a low risk of death - which totally freaked me out yesterday! But then they said if I don't have all this done, the bigger risk is dying from a cardiac arrest as I have VT. So I don't feel I really have a choice but I am currently in shock, scared, concerned for my hubby and family. I am 55.

I have just put a post on here about my situation so may get some replies that will be useful to you too.

Hope all goes well for you.

Best wishes

Janey

Just had a very difficult lead extraction last Thursday- I'm doing great

by primaldiva - 2018-01-10 11:59:35

I was nervous about it too, but after I did extensive research I was able to trust the excellent team of Kristine Patton MD and her amazing PA Lyle Larson at the University of Washington Medical Center. At the time I had an Adapta pacer so I called Medtronic and asked them who on the West Coast did the most extractions.  I am 5 days post-op; they said it was their most difficult extraction ever due to the fact that my vein had occluded (which is quite common) but my body and sprouted an extreme amount of vascular tendrils back to my heart as well as around the old pacer.  I also had a lot of scar tissue and they had trouble getting the generator out. We tried to put the new lead in the His bundle as many are doing now but that didn't work so they threaded a brand new Boston Scientific Accolade system.  They even were able to use the old access as it was not damaged at all. I was out of the hospital after one night, snowshoeing a day later, and the next day even did an interval workout on the bike (to discover that my pacing had dropped to 0%, which is great except I couldnt get my ventricle high enough to exercise, so I'm back in the EP lab Thursday.

Here are a couple of things I learned:

1. This surgery has gotten drastically safer in the past 5 years, but there are still many risks.  You need to take those seriously, but those risks depend on your own health.  Women, patients with vascular disease, diabetic patients, and patients on birth control pills are at higher risk of complications, but this goes for many surgeries.

2. I agree with Rodger that you want to look for a team that does a lot of these, as the complication rate is double for less experienced docs.  Cardiac centers across the country are increasingly encouraging one or two docs to do more of the instead of many doing less. A less experienced doc will do about 12 of these per year.  I disagree that you need to find someone who does 100 though.  There are only a few of those, and I almost missed a chance to have my surgery done by Kris Patton because I was obsessing about this.  She does about 65 a year. Since the major complications in this surgery that can affect mortality and/or involve sternotomy involve the quick intervention of a skilled cardiac-thoracic team, having a superstar extractor in a less than stellar hospital system is less important than a great team overall. 

3. If you want to get really depressed, go to the Heart Rhythm Society website at HRSonline.org and you will find a 157 page treatise on lead extraction (linked below but not sure if it still get stripped) My surgeon was actually one of the authors.  You will be well-versed in everything that can possibly go wrong.  However, if I were you I would spend your energy finding a great team (call your device maker's patient services line for starters) and working on getting your health up to snuff befofre undergoing the procedure, so you can have as easy as recovery as I am having.  

https://www.hrsonline.org/Policy-Payment/Clinical-Guidelines-Documents/2017-HRS-Expert-Consensus-Statement-on-Cardiovascular-Implantable-Electronic-Device-Lead-Management-and-Extraction

I had my Adapta pacemaker installed in my 30s, so I am young like you.  Try not to obsess about all of the "worst case scenarios" and you will be fine.  Oh and avoid google searching articles from pre-2013 about lead extraction.  They are already out of date and will cause you too much stress.  There is a ton of more recent data on the website above.

Best of luck.  Andrea

Lead extraction

by Irob - 2018-01-25 10:44:43

Hi.  I just had my pm replaced after battery died after 10 years. The doc told me during the op that the existing leads still function fine and as they have grown into the heart muscle over 10 years they are difficult to replace, there are no moving parts in the leads so why should they need replacing ?  Nothing to wear out. Hopefully mine are good for another 10 years. Ask the doc why they need replacing ?  It may be a profit making part of the routine if you are not under a free scheme such as the British NHS as i am. The Brit doctor would not carry out any uneccessary extracost procedure i,m sure whereas i know in other countries anything to boost hospital profits is considered acceptable practice.

Hi I am nervous too!

by Jrs0070 - 2018-02-21 23:25:33

I am a 22 y/o female. I’ve had a pacemaker since I was five. Found out yesterday that one of my leads has failed and will need to be replaced but because of how long it’s been in (plus the fact that it was put in wrong as a child) they will need to do two surgeries to get it out. The first once will be like a normal lead extraction where they go in through a small insision and follow m lead for a while and get most of it out. But the second surgery, they will have to open my chest up and take the rest of it out through the bottom. I am scared because the risks were not in the better side and pretty high and death was mentioned a lot. I asked if he could abandon this one and just put a new one in somewhere else as I didn’t want to bleed into my chest during surgery. Right now he’s set my pacemaker up to run my heart with one lead and that couldn’t be done long term due to the affects on my heart since I really need a dual chamber lead thing going on. 

Anyways, he said he would consult with other surgeons in ep who have done more intensive lead extraction last and see what my best option is. I have looked up surgeons around the USA who are the best at lead extractions but I’m still scared. 

I know I’m not much of help, but I am looking forward to some more input on this type of thing.