Introduction

The number of pacemaker devices and implantable cardioverter defibrillator implanted is expected to grow tremendously with an ageing population and an expanded indication in patients at risk for sudden cardiac death.

The patients with these implanted devices are also now surviving longer and a small portion of these patients develop complications that requires these devices to be removed.

The complications could arise from
a) Infection: When a patient develops an infection of the pacemaker or ICD device, the leads* and the pacemaker or ICD must be completely removed to cure the infection.
b) Damage: Sometimes it is discovered that the leads no longer provide reliable connections to the heart. When this happens, the damaged leads need to be replaced, but there may not be enough room in the veins to allow more leads to be added. This necessitates the removal of the damaged leads. However, leads may sometimes be replaced without removing the damaged leads. These damaged leads, however, may send electrical signals that interfere with the pacemaker or ICD.
c) Blockage: Damaged leads that have not been previously removed sometimes block veins entering the heart. In such cases, the damaged leads must be removed in order to allow access to the heart.

What is it

The solution to such patients with pacemaker and ICD complication is lead extraction. When the leads are initially inserted through the veins of the chest and connected to the heart, they can be easily removed. However, there is often progressive growth of fibrous tissues around the lead body and electrode tip that creates a major barrier to the removal of these leads. Simple traction is not successful and may result in not removing the lead completel. This can potentially result in life threatening arrhythmias, thromboembolism or other problems. Hence, lead extraction is used to remove one or more leads from the inside of the heart and veins with special tools that safely release the lead from the scar tissue.

The success of lead extraction depends on the duration that the lead has been implanted prior to removal and presence of multiple leads.

Lead extraction is however technically difficult and not without complications. Women, older patients and patients with multiple leads in place are at higher risk than others. The procedure is done in the operating room under general anaesthesia together with a cardiothoracic surgeon so that all emergency complications can be treated immediately.

In conclusion, lead extraction though technically difficult can be safely and successfully performed in up to 95% of patients. It is an important therapy which must be made available to our patients who have pacemaker and ICD devices implanted should the need arise.

*A lead is a thin, flexible wire that travels through a vein and delivers energy to the heart muscle from a pacemaker or implantable cardioverter defibrillator (ICD) – special devices implanted under the skin that help a patient’s heart beat in a regular rhythm. Two, or sometimes, three leads are used to connect the patient’s heart to the pacemaker or ICD.