The number of pacemaker devices and implantable cardioverter defibrillators (ICD) 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, which requires these devices to be removed.
Occasionally leads are also removed if they are infected.
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 completely. 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.
