Transvenous Lead Extraction

Cardiac Implantable Electronic Devices (CIEDs) include pacemakers and implantable cardioverter defibrillators (ICDs). Both of these devices have wires called “leads” which are used to connect the device to the heart. The leads must be tightly secured to avoid any malfunction, which is accomplished by small screws or tines to make sure they remain in place. Over time, scar tissue develops over the leads, making them hard to remove. Although leads are meant to be permanent, certain situations call for lead removal.

Lead extraction is a minimally-invasive procedure (small incisions of 2–3 inches long / general anesthesia) performed to remove and/or replace leads that are not working properly or if the device/leads become infected.

Do you have a question? Request more information and we will connect you with an RWJBarnabas Health cardiovascular expert.

How to Prepare for the Procedure

Before the procedure, your doctor and treatment team will explain to you what to expect before, during and after the procedure and potential risks of the procedure. Talk to your doctor about:

• All medications, herbal products and dietary supplements you are currently taking and ask for their recommendations about each.
• Diabetes and how to adjust your medicine on the day of the procedure.
• Radiation exposure, especially for those that are pregnant.
• Any allergies to medicines, latex, tape, iodine, and anesthetic agents.
• Any history of bleeding disorders.
• Any body piercings on your chest or abdomen.

Other recommendations include:

• Eat a normal meal the evening before the procedure. However, do not eat, drink or chew anything after midnight before your procedure. If you must take medications, only take them with sips of water.
• Leave all jewelry at home.
• Remove all makeup and nail polish.
• Wear comfortable clothing when you come to the hospital.
• If you normally wear dentures, glasses, or hearing devices at home, plan to wear them during the procedure.

What to Expect Before the Procedure

Before the procedure, your doctor might perform a variety of diagnostic tests, including:

• Blood tests
• Echocardiogram (ECHO)
• Electrocardiogram (EKG/ECG)
• Interrogation of pacemaker or defibrillator

What to Expect During the Procedure

A lead extraction can last anywhere from 2 to 6 hours to perform, but the preparation and recovery may add several hours. Lead extraction is usually performed in the cardiothoracic operating room (OR). Check with your doctor about the details of your procedure. In general:

• You will change into a hospital gown.
• A nurse will start the intravenous (IV) line in your arm which will administer medications and fluids during the procedure.
• General anesthesia will be administered to make you go to sleep. Once asleep, a breathing tube will be put through your mouth into your lungs. The tube will be attached to a machine (ventilator) that will breathe for you during the procedure.
• To start the procedure, your doctor will make a small incision in one of two insertion sites (subclavian vein-upper chest, or femoral vein-groin). Most frequently, the subclavian approach is used.
• After this process is completed, 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).
• Once in place, your doctor will proceed to remove the lead(s). In some cases, they also might place new leads at this time.
• Once the procedure is completed, your doctor will remove the sheath and lead(s). Then proceed to close and bandage the site where sheath was inserted.

What to Expect After the Procedure

After the procedure is finished, you will remain in the hospital for 1 to 2 days. Other recommendations include:

General Guidelines

• A nurse will monitor your vital signs, the insertion site, and circulation and sensation in the affected area.
• Tell your nurse right away if you feel any chest pain or tightness, or any other pain, as well as any feelings of warmth, bleeding, or pain at the insertion site.
• If your leads were removed because of infection, you will likely receive antibiotics after the procedure, either by mouth or through an IV.
• The morning after the extraction, you will have chest X-rays to check your lungs and the position of any new leads that were implanted.
• You may have stitches that will be removed 10 to 14 days after your procedure. Consult with your doctor about this.
• Before you leave the hospital, your doctor and nurse will talk you about activity limits, medications and follow-up appointments.

Do you have a question? Request more information and we will connect you with an RWJBarnabas Health cardiovascular expert.