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Pacemaker and ICD Lead Extraction

What you need to know

  • Pacemaker and ICD lead extractions are necessary when the leads become infected. Extractions may be necessary when wire leads malfunction or are recalled.
  • Removing wire leads from a heart risks damage to the heart tissue. This delicate procedure should only be performed by physicians who are experts in this area.
  • As a leading provider and high-volume center, the Heart and Vascular Institute at Johns Hopkins is equipped to safely handle lead extractions.

Pacemaker and ICD Lead Extractions at Johns Hopkins

When a pacemaker or implantable cardioverter defibrillator is implanted into a patient, wire leads are attached to the patient's heart. When needed, these wire leads deliver an electric shock from the pulse generator directly to the heart. While the pulse generator may need to be replaced every four to ten years, the wire leads are rarely removed from the body. This is because scar tissue may develop around the leads, fusing them to the heart muscle. Sometimes, old leads may need to be removed because of infection or to make room for new leads that may be necessary.

Why Leads May Need to Be Removed

There are two specific times when leads may need to be extracted:

  1. When the pacemaker or defibrillator system becomes infected
  2. When there is a manufacturer's recall or the leads fail

Leads that have been in place less than one year usually can be removed without much difficulty or risk. However, leads that have been in place for many years may require a special laser cutting sheath to free them from the wall of the heart. While this can be a risky procedure, The Johns Hopkins Hospital is a high-volume facility for lead extractions. We successfully remove leads from patients who are unable to be treated elsewhere.

Extracting Leads Due to Infection

Wire leads may need to be removed if they become infected. These infections cannot be treated adequately using antibiotics only. In this case, the complete pacemaker or ICD unit, including the leads, will be removed. While the patient is recovering from the infection, cardiologists will assess the patient's condition to determine if the pacemaker or ICD needs to be replaced. Sometimes patients can live healthy, active lives without a replacement device.

If a patient needs a replacement pacemaker or ICD, a new device can be implanted as soon as the patient has been clear of the infection. From the time the device is removed, patients can expect to be in the hospital for about a week.

Extracting Leads Due to Failure or Recall

As a medical device, there are times when wire leads may fail to function properly or may be recalled by the manufacturer. This occurs in less than 1% of all implanted leads each year. When a device is recalled, patients are strongly encouraged to follow up with their physician, who can discuss the available options.

The Extraction Procedure

The Cardiac Electrophysiology lab

Once it is determined that leads need to be removed from the heart, the procedure will be scheduled. The procedure will take place in Zayed Tower's hybrid operating room. This room can serve as a minimally invasive catheterization lab or a cardiac operating room. Because of the risks associated with tearing heart tissue, scheduling the procedure in this state-of-the-art operating room is critical. In the very rare event that heart tissue is torn, surgeons can immediately perform open-heart surgery without losing valuable time.

Most procedures are routine and The Johns Hopkins Hospital performs many procedures without incident. The patient is given general anesthesia and closely monitored throughout the procedure. When necessary, doctors can remove scar tissue around leads using a laser cutting sheath. This frees the lead to be removed via catheter.

In all, the process may take several hours. Patients can expect to be in the hospital for about one week from the time the leads are removed, depending on the reason for removing the leads.

Refer a Patient

To refer a patient for possible pacemaker or ICD extraction, please contact the Johns Hopkins Heart and Vascular Institute at 443-997-0270.