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Cardiothoracic surgeons at UT Southwestern have the expertise to safely and efficiently remove leads from surgically implanted cardiac devices.

By extracting leads that are infected or damaged, we help limit health complications and take the first steps necessary to restore proper heart rhythm.

Expertise in Laser Lead Extraction

A lead is a thin, flexible wire that delivers energy from a pacemaker or implantable cardioverter defibrillator (ICD) to the heart. It usually travels through a vein to enter the right side of the heart and is screwed directly into the heart muscle.

When leads are not working properly, most commonly because of device infection, they need to be surgically removed. This is called a lead extraction.

Lead extraction is a complex procedure that requires the expertise of a skilled cardiac surgeon. UT Southwestern is one of only a few medical centers to perform laser lead extraction, a minimally invasive procedure that allows us to cut through the scar tissue and easily remove a lead.

Our center is ranked in the nation’s top 15 hospitals for cardiology and heart surgery by U.S. News & World Report for 2020-21. Our clinicians apply the latest research findings in cardiovascular medicine to give patients access to the most up-to-date treatments.

Lead Extraction: Conditions We Treat

Pacemakers and ICDs are surgically implanted cardiac devices that help regulate abnormal heart rhythms. Pacemakers help a heart with a slow or irregular beat run steadily. ICDs are similar to pacemakers, but they can also deliver a shock to reset an abnormal heartbeat if necessary.

Typically, the leads of these cardiac devices stay in the body permanently. However, in certain situations, they need to be removed. These situations include:

  • Device infection (any part of the pacemaker or ICD is infected)
  • Heart valve infection
  • Damaged leads

Less commonly, lead extraction may be necessary because of:

  • Scar tissue at the tip of the lead, which means the lead requires more energy that the device can deliver
  • Vein blockage by a clot or scar tissue
  • Factory recall of a specific lead

Our doctors recommend lead extraction after carefully weighing all aspects of a patient’s medical circumstances.

What to Expect During Lead Extraction

Our skilled cardiologists have extensive experience performing lead extractions.

Before the procedure

Patients may undergo tests before their lead extraction, such as:

  • Blood tests, to help us monitor any post-procedure changes
  • Electrocardiogram (ECG), to evaluate the heart rhythm
  • Echocardiography (Echo), to examine heart function and anatomy
  • Venogram, an X-ray of the veins, to analyze vein anatomy near the device

The night before their procedure, patients should not eat or drink anything after midnight.

We may also recommend stopping certain medications, such as aspirin, a few days before the procedure.

During the procedure

Lead extraction typically takes two to six hours. Our surgical team includes a cardiologist as well as specially trained nurses and technicians.

Most patients receive general anesthesia, which means they are in a sleep-like state during the procedure and don’t feel any pain.

To remove the leads, the doctor first makes an incision near the pacemaker or ICD, removes the battery from the device, and disconnects the device from the lead.

A sheath is then placed inside the vein and over the lead. The sheath is attached to a laser, which delivers energy to remove the scar tissue at the end of the lead. This detaches the lead from the inside of the vein and allows the doctor to safely remove it.

New leads may be placed in a patient’s heart during the procedure or a later date.

After the procedure

After lead extraction, patients will stay in the hospital two to 10 days. If a new pacemaker or ICD is not implanted during the procedure, the patient may be hospitalized until that surgery.

Patients whose leads were removed through their femoral vein will need to lay in bed for several hours after the procedure.

Risks

Lead extraction is generally very safe, though it’s not without risk. Potential complications include:

  • Damage to the heart or surrounding blood vessel
  • Stroke
  • Pulmonary embolism, a blood clot in the lung
  • Fluid buildup around the lung or heart
  • Infection

These risks may increase if the patient:

  • Is female
  • Is younger
  • Has calcified leads
  • Needs multiple leads removed

Support Services

We provide a comprehensive range of support services for patients and their families, including programs related to cardiac rehabilitation and clinical nutrition for heart health.

Learn more about heart-related support services at UT Southwestern.

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