A cardiac lead is a flexible wire coated with insulation that connects a pacemaker or implantable cardioverter defibrillator (ICD) to the interior of the heart. Removal of the lead, also known as lead extraction, may be necessary under certain circumstances, including: 1,2

  1. The lead is not functioning properly.  Sometimes the lead no longer provides a reliable connection between the pacemaker or ICD and the heart. This can be due to damage to the lead, called lead fracture.   Large amounts of scar tissue forming at the tip of the lead may also cause the lead to need more energy to function than the pacemaker or ICD is able to deliver.
  2. A pacemaker infection or ICD infection has developed. The device and leads may need to be removed to cure the infection.
  3. The lead is interfering with blood flow to the heart.  Leads that are not being used may need to be removed if they are blocking the flow of blood to the heart.
  4. There may be a manufacturer advisory on your lead.  If one of your leads has a higher risk of failure than normal and is under a manufacturer advisory, please consult your healthcare provider to see if it should be removed.
  5. MRI inaccessibility.  Newer pacemaker systems are designed to be safe in an MRI environment. The presence of older, non-compatible pacemaker leads may prohibit your access to MRI diagnostic testing if you should need it in the future.

As with any surgical procedure, cardiac lead extraction has risks.  Talk with your doctor about the right choice for you.

 

References

  1. http://my.clevelandclinic.org/heart/services/tests/procedures/pmHome.aspx Retrieved 11/21/11
  2. Wilkoff, B.L., Love, C.J., Byrd, C.L., Bongiorni, M.G., Carrillo, R.G., Crossley, G.H., et al. (2009). Transvenous lead extraction: Heart Rhythm Society expert consensus on facilities, training, indications, and patient management. Heart Rhythm, 6, 1085-1104.