Lead Extraction

Can anyone give me information on lead extractions?
My situation is....I am 34 with my third implant. I will be having my fourth implant within the next couple months. I was also told that I have no more room for leads in my upper chamber as I have one active with two "old inactive" leads. So a lead extraction will need to be done. Since they are doing the upper chamber they will also remove the one "old inactive" lead in my lower chamber. Being only 13 when I had my first pacemaker implanted having my battery changed is no big deal for me, but talking about lead extractions scares me a bit! Any information would be greatly appreciated - THANKS MUCH!

8 Comments

Not so bad

by heckboy - 2008-02-04 06:02:33

Hi,

I had a failed lead extracted last week and the surgery took less than 2 hours. I checked into the hospital at 6:00 in the morning for a 7:30 OP and checked out the next morning. It's clearly a bigger deal than just getting a PM implanted, but aside from more tubes stuck in me than I recall from the first time, recovery has been quicker, maybe because I'm already used to a PM.

The sheath that was used to extract my lead was inserted at the site of my PM. In some cases, they have to go in from your thigh to remove the lead. If you're a man, you can look forward to a shave from your neck to the bottom of your briefs. It's done as a precaution in case of complications and they have to take the direct route to your heart. I look like a plucked chicken.

All that can be a little scary, but like I said, in my case, things went very smooth.

Anesthesia

by VonnieVern - 2008-02-04 09:02:20

Did you have to have general anesthesia, Heckboy?

Lead Extraction

by BOB 1 - 2008-02-04 10:02:17

I had a lead extraction a couple of years ago and had no problems. Below is a partical copy of information from Providence Saint Joseph Medical Center that I was given. It pretty much details my procedure. I was not at St. Jos. but my doctor thought it was an excellent article on the subject.

What is a Lead?

A lead is a thin, flexible wire that travels through a vein and delivers energy to the heart muscle from a pacemaker or implantable cardioverter defibrillator (ICD) – special devices implanted under the skin that help a patient’s heart beat in a regular rhythm. Two, or sometimes, three leads are used to connect the patient’s heart to the pacemaker or ICD.

What is Lead Extraction?

When the leads are initially inserted through the veins of the chest and connected to the heart, they can be easily removed. However, eventually the leads are held in place by scar tissue. Lead extraction is the removal of one or more leads from the inside of the heart and veins with special tools that safely release the lead from the scar tissue.

Why is Lead Extraction Necessary?

A lead must be removed when it becomes infected or damaged or causes a mechanical problem.

Infection. When a patient develops an infection of the pacemaker or ICD system, the leads and the pacemaker or ICD must be completely removed to cure the infection.

Damage. Sometimes it is discovered that the leads no longer provide reliable connections to the heart. When this occurs, the damaged leads need to be replaced, but there may not enough room in the veins to permit the addition of more leads. This necessitates the removal of the damaged leads. However, leads may sometimes be replaced without removing the damaged leads. Damaged leads, however, may send electrical signals that interfere with the pacemaker or ICD.
Blockage. Damaged leads that have not been previously removed sometimes block veins entering the heart. In such cases, the damaged leads must be removed in order to allow access to the heart.

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. At Providence Saint Joseph Medical Center (PSJMC), more than 150 cases of infected systems have also been implanted during the same surgery, with only a 2% re-infection rate in 14 years. 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 at PSJMC 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.

General

by heckboy - 2008-02-04 10:02:54

Yeah, I was out like a light. Much deeper than when I got my PM. I felt groggy for 45 minutes after they woke me up.

Thank you

by Pacing13 - 2008-02-04 11:02:36

Thanks to all of you that have replied, all great information. You would think after having pm for 22 years I would understand it more.

Does anyone know when the terms lead infection is used, what exactly does that mean? I have had some wierd things happening in my body that no one can explain....could it be because I have "spare" parts in me?

New to this site bare with me if I am not doing this right.
Thanks,
Pacing13 (Tracie)

Lead extraction last year.

by swilson10 - 2008-02-05 01:02:17

Tracie,
I actually was at the above hospital last May and found that after 3 other PM procedures this was the best overall experience of all. I would be happy to answer any specific questions so please feel free to send me a private message. Welcome to the club!

Scared

by afreed - 2011-06-30 02:06:18

I am about to go through lead extraction...how did it go? Any advice to offer? I was found not to need a pacemaker and I have decided to have the leads/pm removed rather than keep them in my entire life (I am 30). I am super scared!!!!

Lead extraction

by peanutdeanna - 2017-05-30 11:09:36

I am scheduled to get my pacemaker and leads extracted next Wednesday because I do not need them. I am very scared but I am in pain as well and I am ready to feel better. Any advice needed. I am so nervous. 

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The experience of having a couple of lengths of wire fed into your heart muscle and an electronic 'box' tucked under the skin is not an insignificant event, but you will survive.