Leads are insulated wires that run from the heart to a pacemaker or implantable cardioverter-defibrillator (ICD). If there’s an infection or malfunction, it’s necessary to remove them. Extraction is a complicated procedure because it requires navigating tough scar tissue that holds leads in place.
A lead extraction is the removal of one or more leads from inside your heart. (This procedure can’t remove leads placed outside of the heart during open-heart surgery.)
After the initial device implant procedure, scar tissue forms, securing the lead in place. This tissue builds up over time, causing the lead to need more energy to function than the device can deliver. Healthcare providers call this an “exit block.”
Scar tissue buildup also makes leads challenging to remove. Special instruments and the skills of an experienced cardiac provider are necessary to free the lead without damaging the blood vessel.
A lead is a special wire surrounded by insulation that delivers energy from a pacemaker or implantable cardioverter-defibrillator to your heart. These devices are for people who have or are at risk for abnormal heart rhythms (arrhythmias). They help maintain a steady heart rhythm.
When the device detects an arrhythmia, it releases a burst of energy that travels along the leads to your heart. This resets the heart to a normal rhythm.
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The most common reason for lead extraction is device infection usually spreading to the lead from an infection of the blood (bacteremia). Heart valves may also become infected (infective endocarditis). In both cases, your healthcare provider will remove the device and leads.
Additional reasons for lead extraction include:
The subclavian approach is the most common. Your healthcare provider extracts the leads through an incision in your subclavian vein, under the collarbone (clavicle).
The other approach is through an incision in the groin next to the femoral artery. Healthcare providers use this approach when the subclavian approach is not possible.
Here’s what to expect:
Your provider can also use a laser device that’s attached to the tip of the sheath. Laser energy creates heat that vaporizes scar tissue.
Sometimes your provider will implant new leads during the extraction procedure, sometimes later. It depends on the reason for lead removal. If there is an infection, it’s essential to get rid of it before implanting new leads.
The benefits of lead extraction depend on why you need the procedure. Extracting leads may result in:
As with any invasive procedure, there are risks. These include:
Patients typically need to stay in the hospital overnight, but sometimes longer. You may need to:
Call your healthcare provider if you experience:
A note from Cleveland Clinic
Lead extraction is a procedure to remove heart device leads. You may need this procedure if the leads become infected, broken or defective. Lead extraction is a complex procedure due to scar tissue that holds the leads in place. For the best results, seek treatment from an experienced healthcare provider.
Last reviewed by a Cleveland Clinic medical professional on 07/12/2022.
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