Long-term Cardiac Device Lead Management in Adults

Sometimes, people with cardiac devices require an extraction procedure to replace the device or its wires, called leads.

NYU Langone experts monitor you for any changes in your heart condition, which can indicate that you need to switch to a different device. For instance, if you develop a heart problem caused by fast rhythms in the heart’s lower chambers, your cardiac electrophysiologist may need to remove a pacemaker and insert an implantable cardioverter defibrillator, or ICD.

If you develop heart failure, additional wires, which connect to the heart’s ventricles, may be needed to resynchronize your heart.

Lead Extraction

Though pacemaker and ICD wires, or leads, are designed to remain in the body indefinitely, sometimes they stop working properly. This can happen when a lead breaks or lead insulation wears out. When this happens, your doctor may recommend removing the leads and replacing them.

Doctors may also perform lead extraction if a “pocket” infection forms in the area where the cardiac device is implanted, or if there is a wire-related infection in the bloodstream or the heart. If this occurs, the wires must be removed so the infection can be managed.

Other reasons to remove leads from the body include manufacturer recalls, blocked veins where the wires are placed, and a change from a pacemaker to an ICD, which requires different types of leads.

Because the leads run through veins to the heart, the body forms scar tissue along the devices, often binding them to the wall of a blood vessel or the inside of the heart, making them difficult to remove.

At NYU Langone, our arrhythmia specialists are pioneers in lead extraction procedures. They may use mechanical dilators to remove scar tissue from the wires, lasers to free the lead from the vein and heart tissues, or a locking stylet, which is a thin wire that provides traction to pull the lead from the vein without damaging it.

Your cardiac electrophysiologist performs a lead extraction in the hospital using general anesthesia. He or she makes an incision in the area of the chest where the device was implanted, removing the device and disconnecting the leads. Next, the doctor places a thin, flexible tube—or sheath—over the lead that is to be removed. The sheath is passed along the lead into the vein and toward the heart. Your doctor frees the lead from the vein and removes the lead from the body, then implants a new lead.

If leads are replaced because you have an infection, your doctor may leave the incision open temporarily after the procedure to allow for drainage. An external cardiac device may be used until the infection clears up.

Device Replacement

The average pacemaker battery lasts about 7 to 13 years, and an implantable cardioverter defibrillator battery typically lasts 5 to 10 years. When the battery reaches its replacement time, surgeons implant a new device, frequently using the original leads.

Doctors use a sedative and a local anesthetic to numb the skin on the chest. Next, an incision is made below the collarbone, usually through the previous incision. If new leads are required, the original ones may be removed. Then your surgeon removes the old device and replaces it with a new one, attaching it to new or old leads.

Electrical measurements of your heart are taken to ensure the leads are working properly before they are connected to the new device. Your doctor tests a new pacemaker or ICD to make sure it works.

The battery is welded inside, so the entire device—rather than the failing battery—is replaced.

The procedure takes 30 to 60 minutes. If new wires are not implanted, you may not need to stay overnight in the hospital.

Your doctor schedules a follow-up visit for two weeks after surgery to test the device and check the incision for proper healing.

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