What is a lead?

A lead is a special wire that delivers energy from a pacemaker or implantable cardioverter defibrillator (ICD) to the heart muscle.

What is a lead extraction?

A lead extraction is the removal of one or more leads from inside the heart. Leads that are placed outside the heart during open heart surgery cannot be removed during this procedure.

Why do I need a lead extraction?

Your doctor has determined that your lead or leads need to be removed for one or more of the following reasons:

  • 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) is able to deliver. This condition is known as “exit block.”
  • An infection at the site of the device and/or lead
  • Blockage of the vein by a clot or scar tissue 

How is lead extraction performed?

There are two approaches to lead extraction:

Subclavian Approach

The subclavian approach is the most frequently used approach. The leads are extracted through an incision in the upper chest over the subclavian vein.

Femoral Approach

The femoral approach is used when the subclavian approach is not possible. The leads are removed through a small puncture in the groin over the femoral vein.

Removal of the lead


A special sheath (tube) is placed in the vein. This sheath is threaded over the lead and guided to the tip of the lead (where the lead attaches to the heart).


A laser light or mechanical drill-like tip can often be attached to the sheath to help break up the scar tissue.


The lead is then removed.

Are there risks to having a lead extraction?

A lead extraction is generally a very safe procedure. However, as with any invasive procedure, there are risks. Your doctor will discuss these risks with you, and special precautions are taken to decrease these risks.

Although results and risks vary from patient to patient, over the last 10 years, the overall success rate for lead extraction at Cleveland Clinic is greater than 99.5%. The risk of internal bleeding, tear in a vein or heart, or death is less than 0.5%.

This information is about procedures and may include instructions specific to Cleveland Clinic. Please consult your physician for information pertaining to your specific procedure.

Reviewed: 05/15