Patients who have a heart rhythm disorder (arrhythmia) may be treated with a cardiac device such as a pacemaker or an implantable cardioverter-defibrillator (ICD). Attached to these devices are small wires, known as leads, that deliver the energy from the device to your heart, helping to regulate its rhythm.
While these treatments are often successful ways to treat heart rhythm disorders, about 2% of recipients experience issues, such as infection or device malfunction, that require a lead extraction procedure.
Expertise in laser lead extraction
At University of Iowa Heart and Vascular Center, our cardiac electrophysiologists are the only providers in the state performing laser lead extraction procedures. Our experts can remove the leads causing complications and, in some cases, replace them with new implants.
Lead extraction procedures are performed in our state-of-the-art cardiac catheterization lab. Our lab uses the latest technologies to provide minimally invasive surgical interventions, improve outcomes, and help you get back to your life faster.
Largest volume in Iowa
Our specialists complete over 120 extractions per year, making UI Health Care the highest volume lead extraction center in Iowa.
How lead extraction works
There are two approaches to lead extraction. The first and most common is called the subclavian approach. This involves extracting the lead through an incision under your collarbone. If this approach is not possible, your provider will remove the lead through an incision next to the femoral artery in the groin area.
What to expect during lead extraction
Before the procedure
Patients may have several tests done before their lead extraction, including:
- Blood tests, to monitor any post-procedure changes
- Chest x-ray
- CT to look at interaction of the leads with the tissue
- Electrocardiogram (ECG), to evaluate heart rhythm
- Echocardiogram (Echo), to examine your heart’s anatomy and function
- Venogram (X-ray of veins), to evaluate the anatomy of veins near the device
Other recommendations and instructions may be given by your care team before the procedure.
During the procedure
Most patients will be put under general anesthesia. The electrophysiologist will then create an incision and place a tube in your vein called a sheath that has a laser attached to the tip. The laser will help remove tough scar tissue surrounding the lead to extract it.
From there, the electrophysiologist will cover and extract the sheath and lead, using imaging technologies to guide and monitor the removal. After removal, they may place new leads, if necessary, before closing the incision site.
After the procedure
After the procedure, you will spend at least one night in the hospital to be monitored. During your stay, you will receive pain medications and antibiotics (if needed) and complete a follow-up X-ray to help make sure your heart and lungs are functioning as they should.
If your lead extraction procedure went through your groin area, you will be required to lie flat for several hours after the procedure to prevent bleeding.
Once released from the hospital, you will be provided with at-home care instructions for medications, rest requirements, dietary needs, and wound care. You will also need to return for follow-up appointments to monitor your recovery. While recovery times vary from person to person, you should be back to your regular activities after a few weeks.
Please call your provider if you experience any fever, swelling, bleeding, or drainage at the incision site, or difficulty breathing during your recovery.
Who can benefit from lead extraction?
- Device or lead infections
- Heart valve infections
- Damaged leads
- Device or lead malfunctions or recalls
- Excess scar tissue interfering with the device
- Blood clots due to an obstructed vein
- Arrhythmias triggered by the device or the lead
Lead extraction is a complex, specialized procedure for patients who need to have their leads removed. If you believe you are experiencing complications due to your cardiac device, our providers can help you determine if lead extraction is right for you.
Lead extraction is generally very safe but does come with some risks. Potential complications include:
- Damage to the heart or surrounding blood vessels
- Pulmonary embolism (a blood clot in the lung)
- Fluid buildup around the lungs or heart
Risks can also increase if the patient:
- Is female
- Is younger
- Has calcified leads
- Needs multiple leads removed