Lead Revision and Removal

Pacemakers and implantable cardioverter defibrillators (ICD) use wires called “leads” to send electrical signals to the heart. Depending on the type of device, there may be one, two, or three lead wires.

A lead delivers energy from a pacemaker or ICD to the heart muscle. Lead removal is the extraction of one or more leads from inside the heart.

Over time, the leads may stop working properly due to damage within the wire itself or because of scar tissue build-up around the lead. Infections can also develop where the lead or the cardiac device has been implanted. In these cases, the entire device and all leads must be removed and/or replaced.

Why choose Presbyterian for your lead revision and removal?

Presbyterian Heart and Vascular Care has a skilled electrophysiology team who can provide a wide range of cardiac rhythm treatments. Their electrophysiology cardiologists are trained in many different techniques and procedures, many of which can provide you with a shorter recovery period and the opportunity to recover at home.

Who is eligible for a lead revision and removal?

The kind of patient eligible for lead revision and removal has a pacemaker or ICD device with wire leads inside the heart.

Tests that can detect problems with leads include:

• MRI, which finds damage to the heart or aorta.


• Angiogram, which looks for blockages in specific arteries.


• Chest X-ray, which is used to examine your heart, lungs, and blood vessels.


• Echocardiogram, which uses sound waves to visualize the structure and motion of the heart.

What conditions can be treated with a lead revision and removal?

Your doctor may determine that your lead or leads need to be revised or removed for one or more of the following conditions:

• Blockage of the vein by a clot or scar tissue.


• An infection at the site of the device and/or lead.


• Damage to the inside (called a fracture) or outside of the lead.


• Large amounts of scar tissue forming at the tip of the lead. This causes the lead to need more energy to function than the device (pacemaker or ICD) can deliver. This condition is known as “exit block.”

How do I prepare for a lead revision and removal?

You will receive instructions on how to prepare for the procedure. Here’s an overview:

Your doctor may ask you to stop taking certain medications a few days before your procedure (such as blood thinners and aspirin). Do not stop taking any medication before checking with your doctor.

Do not eat or drink anything after midnight the night before your procedure.

What should I expect during my lead revision and removal?

• The procedure will take place in a special surgical room.


• You will lie on a surgical table, and the nurse will start an intravenous (IV) line to give you fluids and medications during the procedure.


• You will likely be given general anesthesia to sleep through the procedure.


• You may also have an arterial pressure line placed in an artery in your wrist or groin, and an IV will likely be placed in a vein in your groin. This access can be used to insert a pacemaker wire to keep your heart in rhythm when your pacemaker is removed or insert tools used to remove the leads.


• If groin access is needed, the area will be cleaned and numbed. A needle will be inserted in the vein in the same way an IV is started in your arm, only using a larger needle.


• If your pacemaker/ICD is being replaced during the procedure, a catheter used to pace your heart will be inserted into the vein and guided to the right side of your heart. If you are receiving a new pacing device at another time, the temporary pacemaker wires may be placed in your neck.


• All catheters and temporary pacing equipment are removed at the end of the procedure and the areas are covered with bandages. The goal is to gently “pull” the lead away from tissue in which it is embedded or attached to the heart. There are advanced tools such as lasers that can help gently free the lead.


• There are two approaches to taking out the lead:
  
  
  • Subclavian Approach: The leads are taken out through the upper chest.
  
  
  • Femoral Approach: The leads are removed through a small puncture in the groin over the femoral vein.
• This procedure takes two to six hours. You will be transferred to a hospital room and stay for 2 to 10 days.


• While in the hospital, you will be placed on a telemetry machine to monitor your heart rate and rhythm.


• You will have a chest X-ray to check your lungs and the position of any new leads that were implanted.


• Before you leave the hospital, your doctor and nurse will talk with you about activity limits, medications, and follow-up appointments.

How do I care for myself after my lead revision and removal?

You may have stitches that will be removed 10-14 days after your procedure.

If your leads were removed because of infection, you will receive antibiotics. They may need to be continued at home. A home healthcare nurse can help.

You should look at your incisions every day using a mirror. Call your doctor if you notice:

• That you have a fever.


• Increased bleeding or drainage.


• Increased swelling at the excision site or in an extremity (i.e., fingers, toes).

If you have any questions after you return home, call your doctor.