The Ohio State University is a leading center in the world for lead extractions. Patients have been referred from around the world and from all over the United States for our expertise and experience. The procedure is performed by heart rhythm specialists (called electrophysiologists) and a specialized electrophysiology staff who have tremendous experience with lead extractions. Our staff have performed thousands of lead extractions, completing more than 400 leads extraction procedures each year. The Ohio State University has extensive experience in all advanced extraction technologies including: mechanical sheaths, fiber optic sheaths for laser removal, electrosurgical sheaths (known as Bovie) and rotational cutting edge sheaths. Ohio State’s electrophysiology program is the largest program in Ohio, and one of the top three in the nation, with extensive experience in managing a wide spectrum of heart rhythm problems.
What is Lead Extraction?
Lead extraction is a procedure to remove a pacemaker or implantable cardioverter defibrillator (ICD) wire or wires from the veins and heart. These wires are commonly referred to as leads.
Why Might I Need a Lead Extraction?
The most common reasons for a lead extraction is an infected device pocket, an infection in your bloodstream (especially if it is related to the lead or leads), or a broken or malfunctioning wire. A blockage of one of your veins is another reason why you may need this procedure, as extracting a lead can also open an area of blockage to allow new leads to be inserted.
What to Expect During Lead Extraction
Preparing for Your Procedure
Before an extraction procedure, you will be evaluated by a heart rhythm specialist (electrophysiologist) to formulate a specific plan for the removal of the wires. In addition to planning the extraction, a decision will be made to determine if another device needs to be re-implanted, either in a permanent or temporary manner. Many patients will also require an echocardiogram, an ultrasound image of the heart, as well as blood tests and sometimes, blood cultures.
During Your Procedure
Lead extractions are performed in the electrophysiology laboratory with a staff that specializes in performing lead extractions. In preparation for the procedure, your chest will be cleaned and you will receive antibiotics to minimize your risk of infection. You will receive medications to help relieve pain and to help you relax.
Many leads are able to be removed by simply pulling on them. However, if your lead has been in place for a number of years, scar tissue will have formed around it making it harder to remove. In this case, a locking stylet (thin wire) will be placed into the center of your lead. This will allow your physician to pull your lead out from its tip. Once the stylet is in place, a sheath (tube) is placed over the lead. The sheath frees the lead from any scar tissue and can be made of plastic, have fiber optics for laser cutting, electrical contacts for electrosurgical cutting or a rotational cutting edge.
In cases where the lead has broken and cannot be grasped from the pocket area of your device, the lead may need to be grasped with a snare from a vein in the groin area.
The success rate for this procedure is 98 percent. Success is defined as removing the entire lead (or nearly all of it) while accomplishing the goal of the procedure (opening a blocked blood vessel or removing an infected system) without a major complication.
What Happens if the Leads are not Extracted?
One option is to leave old leads behind if they are not infected. Infected leads MUST be removed in order to eliminate the infection. Antibiotics alone will not eliminate a device-related infection. If the leads are not infected, they can be left behind, but they become more difficult and risky to remove as time goes on. For younger patients, extraction is highly recommended for old, unused leads. For very elderly patients, leaving an old and non-infected lead behind may be the best therapy and is quite reasonable for many patients.
After Your Procedure
Patients are monitored carefully to assess for any complications and to recover from the procedure. Patients will remain in the hospital for at least one night after an extraction procedure, but, particularly for patients with an infection, further therapy to treat the infection may require the patient to remain several more days in the hospital. A specific plan for the patient will be coordinated by the electrophysiologist.
As with any invasive procedure, there are risks involved with lead extraction. The major risks are tearing a hole in a vein or in the heart. These risks increase for leads that have been in the body for many years. The overall risk of a tear occurring during this procedure is low but depends on several factors, especially the type of lead being extracted, how it is constructed, and the time since it has been implanted, as well as your physician’s experience. If a tear in the vein or heart does occur, a tube is placed in the bleeding area to drain the blood. Many of these leaks will seal on their own, but if needed, a cardiothoracic surgeon may be required to close the leak.
Lead Extraction at The Ohio State University Ross Heart Hospital
Doctors at Ohio State University have not only been doing lead extraction since 1988, but have helped to pioneer all of the tools currently being used for extraction. The first electrophysiologist in the world to use the laser for lead extraction was Dr. Charles Love.