Pacemaker & Defibrillator Lead Extraction

Pacemakers and cardioverter defibrillators deliver energy to the heart muscle through a lead. The removal of one or more leads from inside the heart is a procedure called lead extraction. SSM Health’s heart and vascular team is well equipped to perform this procedure when your condition requires it.

When is Lead Extraction Necessary?

Lead extraction may be required due to a number of reasons, including:

• Damage to the inside (fracture) or outside of the lead
• Malfunctioning leads that cause chronic pain or contribute to an irregular heartbeat
• Infection at the site of the device and/or lead
• Additional heart complications that interfere with the pacemaker or defibrillator

How is Lead Extraction Performed?

There are two approaches to lead extraction:

• Subclavian approach: extraction is done through an incision in the upper chest over the subclavian vein; most frequently used
• Femoral approach: leads removed through a small puncture in the groin or over the femoral vein; used when subclavian approach is not possible

Should a device need to be removed, new leads will also need to be inserted. Because veins have a limited capacity, replacing leads can be challenging. In fact, many physicians who implant devices prefer to avoid removing them due to the potential risks.

Over time, scar tissue builds up around the leads and strongly adheres to the body’s vessels. Historically, physicians would simply pull leads from the arteries, potentially leaving behind broken lead fragments.

Laser Lead Extraction

SSM Health Saint Louis University Hospital and SSM Health St. Mary’s Hospital - Madison heart and vascular surgeons and electrophysiologists use a procedure called laser lead extraction. In this procedure, they partner together to insert a sheath wrapped in laser fiberoptics through the targeted vein and over the lead. Laser energy then breaks up the scar tissue and frees the lead for easier extraction.

To learn more about the procedure, make an appointment with an SSM Health heart and vascular specialist. They’ll complete a thorough exam, review any previous testing you’ve had done, and discuss your best next steps.