At MICC, our cardiologists remove pacemaker or defibrillator leads using special catheter-guided lasers. A lead is the wire that connects your device to your heart. The lead delivers energy from the battery directly to the heart muscle. These devices are used to help patients maintain a normal heart rhythm. If a cardiac lead or pacemaker is infected, not working properly, or builds too much scar tissue, it may need to be extracted.
Prior to the development of this laser procedure, leads were removed surgically and often resulted in damage to the heart tissue. This new technique uses cold, controlled laser energy to free the lead from surrounding scar tissue. This lets the doctor safely remove the lead with little risk.
The laser lead extraction procedure takes two to four hours. You will be asleep during the procedure. The doctor first makes a 5-centimeter incision on the left side of the chest, usually in the same place where your original device incision was made.
Through this incision, the doctor removes the battery from your device and disconnects it from the lead.
Then a sheath, or tube, is inserted inside the vein and over the lead that needs to be removed. Your doctor guides this sheath down to the tip of the lead, where it attaches to the heart. The sheath helps stabilize the heart muscle while the lead is removed.
The doctor may then implant a new lead and/or a new device right away, or this may be done at a later date. This depends on the reasons for having the lead extracted in the first place. If there was an infection at the lead site, it is preferable to wait until the infection heals before placing new leads. Your doctor will recommend the appropriate course of treatment for your specific situation.
After the procedure is complete, the doctor then closes the incision and applies bandages to the incision site.
What to expect after
After the procedure, you will be moved to a recovery room for several hours, and then to a regular hospital room for the night. Most patients are able to go home one or two days after laser lead extraction. If you need to be treated for an infection at the lead site, you may need to stay in the hospital a little longer.