possible lead extraction

Hi All,

I've had a dual chamber pacemaker (due to congenital heart block) for the past 16 years. I'm scheduled in a couple of weeks for my third generator change. Not to concerned about that, but it was recently suggested to me by my EP that I may be in need of lead extraction. Ok I have to admit I had never even heard of this until a few weeks ago. So now I've been reading about it like mad and must say I'm pretty afraid of it. He says that in younger patients like myself he doesn't like to leave old leads in and simply thread new ones in, he doesn't like the extra floating around I guess. Anyway he's the only one that does extraction in the area. I'd like a second opinion. Are we allowed to mention hospitals/doctor names here? I have scheduled an appt at the cleveland clinic for a second opinion. Confused by everything I'm reading/hearing. I also have 2 little kids and I'm more frightened about the surgery due to that then anything else. Comments? Thanks!

6 Comments

lead extraction

by luckyloo - 2007-06-16 11:06:28

hi there,

WOW, you could be me! i am soon going to be faced with the same dilemma. i have an old capped off lead that i was told needs to come out because i'm young and as the lead stays in year after year they get harder to remove. my u of mich dr. says, keep it in until you have another lead problem...they don't remove leads. my dr. here in my hometown says it must come out but they don't do very many either. dr. daubert at u of rochester in new york suggests leaving it in until another lead problem because they use lasers and can damage the good leads resulting in all leads being replaced...if that happens. i went to cleveland clinic and saw dr, bruce wilkoff, he says it must come out because of all the problems leaving it in can create...more scar tissue and every time you open up the area of the device your chances of infection to the leads and device pocket increase dramatically. i am due for a device change also. i am 43 with 2 kids 12 and 10 and i too am very scared. there are great risks to having these removed but i also don't like what can happen when you leave them in.

who are you seeing at CC? dr. wilkoff invented the lead extraction procedure along with dr. love (at ohio state) and another guy in florida. dr. wilkoff is very nice. i am going to make sure no residents "practice" on me. risks go up when residents/fellows do the procedure even with the dr. standing right there. they have to have cardiothoracic surgeons standing by too, incase the laser cuts a major vessel. CC is #1 in the world for heart.

email me privately and i can send you a link to a really good CC site that talks all about lead extraction. you actually listen to the big lead extraction experts talk about things. there are pictures too. it's really neat but kind of scarey to hear. i have an appt. with dr. wilkoff next week to discuss all of this.

sorry to talk so much but your story is exactly like mine!

take care,
luckyloo

lead extraction

by bambi - 2007-06-16 11:06:48

I had to have both my leads extracted last July. Yes, there are risks, but the procedure is now done with a laser sheath that burns away the scar tissue as it goes. This means there isn't the tugging and pulling that used to cause the major problems. You could not go to a better clinic then than the Cleveland Clinic. I applaud you for seeking a second opinion! My Dr. consulted with the Cleveland Clinic before he did my surgery. Thankfully my extraction was successful and I had no problems. I wish you the best!
Bambi

lead extraction

by patpeter - 2007-06-17 06:06:32

I have never had a lead removed but I had to have one replaced in Dec. 2006 and they didn't take the bad one out. They don't remove them at the hospital I was at, but my MD said it was OK to stay in. After reading your post I'm wondering why yours are being removed? And I'm a little worried that maybe mine should be removed also? Hope all goes well with your extraction, take care.
Pat

Lead Extraction

by SMITTY - 2007-06-17 12:06:31

Hello,

So far as I know we can name doctors and hospitals, so long as we do not make derogatory remarks about them. I have named my doctors without a problem.

I can understand your being concerned about the lead removal. Below are some excerpts from an article on this subject which I hope makes you feel a little better.

Good luck,

Smitty


How is Lead Extraction Performed?

The patient receives general anesthesia before the surgery. The extraction is performed by hooking a special wire onto the inside of the lead, or by placing a snare through a vein to grasp the outside of the lead. The physician then pushes a plastic tube with a laser over the lead to help separate it from the scar tissue in the veins and the heart. The plastic tubes, or sheaths, break the scar tissue to prevent tearing the veins or heart. The new leads and pacemaker or defibrillator are implanted during the same surgery. This has saved many patients multiple surgeries or prolonged hospital stays. Patients usually leave the hospital the day after the procedure. If everything goes as planned, the patient should be able to resume normal activities relatively soon after the surgery.

What Are the Outcomes of Lead Extraction Surgery?

Lead extraction was not consistently performed until 1988 when better tools became available to safely release the lead from the scar tissue. A registry of lead extraction procedures has been carefully maintained since that time. Usually the complete lead is removed; however, sometimes a small segment is left behind. This is usually not a problem and may be enough to allow the patient to continue living with no further interference from the partially removed lead. Approximately 90% of all leads are completely removed with current techniques.

What Are the Complications of Lead Extraction Surgery?

Complications are uncommon, in experienced hands, and may include bleeding from the vein or heart. Since 1988, the mortality has been less than 0.25%, but this varies throughout the U.S. The risk and success of lead extraction depends on having the best tools, taking appropriate precautions and utilizing an experienced physician and team.

Lead Extraction

by greenhouse92 - 2007-09-27 12:09:01

I am scheduled to have my old ICD leads extracted, due to a low grade infection, in October at the Cleveland Clinic by Dr. Wilkoff. Hopefully they will not have to extract the ICD leads on my functioning unit.

My first ICD was put in in 1995 at St. Luke's Hospital in Houston.. A replacement was put in in 1999 at Massachusetts General Hospital. I got an infection in 2002 and the unit was taken out and most of the wires were cut off at the clavicle at St. Luke's. Now the rest of those wires have to be taken out.

I did tons of research before selecting Dr. Wilkoff at the Cleveland Clinic. Dr. Charles Byrd in Fort Lauderdale, Florida also has performed many extractions. It appears to me that there are not many Doctors in the U.S. who perform lots of lead extractions.

Is that what many of you are finding?
Thanks

Lead Extraction

by dmancill - 2007-11-12 12:11:47

I had my pacemaker removed in July of 2007. A new Cardiologist and a new EP said they did not think I needed it. Long story. I wanted the leads removed however it is very risky and after much research and my EP's opinion I decided I was too freaked out to have the leads removed. My EP Dr. Seger has remove hundreds of leads and he is with St. Lukes Hospital in Houston Texas and I was told if anyone could remove them it would be him. But I did take his advice and leave the leads in because of the risks.

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