Advanced Pacer Lead Management and Extraction

Many factors have led to a dramatic expansion in the implantation of cardiac rhythm management devices such as pacemakers (PCM), implantable defibrillators (ICD) and cardiac resynchronization therapy devices (CRT). This includes an aging population, expanded indications for ICD therapy and the role of CRT in the management of heart failure.

A lead is a special wire that delivers energy from a pacemaker or implantable cardioverter defibrillator (ICD) to the heart muscle. Holy Cross Hospital performs lead extractions to remove 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.

The doctors at the Jim Moran Heart and Vascular Center can determine if 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.

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.

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.