Lead Extraction

Hello there, 

I had my first defibrillator implanted in 2001 after my cardiac arrest. Since then I have had 2 more implanted. I was 26 years old when I received my first one and my Cardiologist decided to implant it through my under arm and sub muscular. This was great until lately,  with my 3rd one. The wires are very close to the surface and I am getting cysts and inflammation from them. Unrelated I happened to get sepsis 2.5 years ago and had to have Open heart surgery to repair my Mitral Valve. A cardiothoracic surgeon recommends removing the whole system, defibrillator and extracting the leads that have been in for 23 years and installing all new. He also mentioned possibly having to move my defibrillator to the right side of chest. From what I have read about extracting old leads, I am terrified that I will end up with open heart surgery again, having them damage something else, or possibly worse. The cardiothoracic surgeon says he does extractions about 5x a week. If any of you have had old leads extracted or any lead extraction can you tell me your experience. Also if anyone has their defibrillator on the right side, do you have any issues with shock not being as effective? Sorry so long.  

6 Comments

Are you getting treatment for the cysts/inflammation?

by Gemita - 2024-05-16 08:55:22

Lunaeclipse, I see you have had a complicated history and I am so very sorry to hear all about this.  What is important now is your absolute safety and any hint of any remaining infection or risk of infection on leads or device really needs dealing with.  I am uncertain from your comments if this is the reason for the recommendation to extract the entire system.  If it is then I am afraid in your shoes I would find the best surgeon (even if you have to travel) to do this for you and to get the old system out in case traces of infection remain.  You may not get a second chance with an infection like Sepsis, although I appreciate this was related to a valve.

There are several members who have successfully had leads extracted and I hope they will see your post.  I see no concerns having a defibrillator on the right side of your chest, although clearly the leads will need to be long enough to reach the right side, perhaps this is also the reason why you will need a completely new system?

I send you my very best wishes and hope that you are able to find a good surgeon who is able to help you if you do not feel your current surgeon is up to the job?  A second opinion in these circumstances is always wise.  I would also see your general doctor for treatment of your cysts/inflammation.  If this gets worse you will only complicate further treatment.

Right-sided pacer/ICD

by Julros - 2024-05-16 10:56:41

My current and previous device are/were on my right side. The EP said this was because I am left-handed. The wires do not really need to be longer, as your heart is close to the middle of your chest. And there is usually plenty of slack in the wires. If you look at a chest xray of a pacemaker, you will often see the wires coiled around the device. 

I had a lead extraction 2 1/2 years after the initial implant, due to needing an upgrade to an ICD. The vein that the wires passed through was scarred around the wires, and they were prepared to use a laser to extract them. This turned out not to be necessary and they used a cutting catheter instead. 

You have an experienced surgeon doing your procedure so that is great news. They will take every precaution to prevent open heart surgery, so there will be a ton of people present, just in case. It sounds like you are in good hands. 

extraction

by Tracey_E - 2024-05-16 11:12:19

I have not had an extraction yet but expect to extract my 30 year old leads later this year so have done a ton of research and had multiple extended discussions with my EP. 

Extraction has come a long way in the last ten years. The lasers they use are much improved, they have new tools to stop bleeds which makes it much less dangerous, and the number of experienced surgeons has skyrocketed. Five times a week is great. You can ask how many times he has had to do open heart when extracting.  They can also do testing to see the condition of the leads as well as condition of the veins to determine risk level. 

Are you a candidate for the leadless icd? 

Extraction

by Lunaeclipse20 - 2024-05-16 14:26:56

The cyst was cultured and it is not infected. It is more of an inflammation from wires rubbing against it. I am not sure if I am a candidate for the lead less. No one has mentioned it from the 2 surgeons I have interviewed. One of the surgeons said he only lost 1 patient and I believe 3 led to open heart surgery. I just hate that my leads have been in 23 years. 

Lead Extraction

by doublehorn48 - 2024-05-16 19:00:28

I had two leads extracted in 2017 and had no problems. One of them is fraying and needs to be extracted again in less than a year. I've had to find another doctor. I locate a hospital and then a doctor at that hospital.  There are two Cleveland Clinic and one Mayo Clinic branches in Florida. That's where I would probably start when looking for a hospital. You do what you can do. Find the most qualified loction and doctor. You are having problems and I'm sorry. But that's what I'm doing and that's my advise to you.

My best,

m. scott

Hugs

by Lavender - 2024-05-16 22:25:39

I'm sorry you're having to go through this. I'm only three years into my first CRT-P, a Boston Sci, and already know when the battery wears down, I will be looking at a lead replacement or reposition. I'm not happy about it because only three years ago, I was told I was "fixed". 
 

Twenty three years with leads in is wonderful. I wish they only had to "fix" us once. Hoping your troubles are resolved in the best way possible. There's definitely some comfort in knowing that the surgeon does this 5X a week, though. You're not his first rodeo. 

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