Lead extraction is a surgical procedure to remove one or more of the leads (wires) from an implanted cardiac device such as a pacemaker or ICD. Over time, leads can become embedded in the heart wall through fibrous tissue growth, making removal complex and requiring specialist expertise.
Why leads may need to be extracted
Common indications include:
- Infection: infection of a device or its leads is a serious complication typically requiring complete system removal, antibiotic treatment, and then re-implantation
- Lead malfunction: a fractured, dislodged, or poorly performing lead producing inappropriate therapy may need to be removed
- Upgrade or revision: extraction may be required to clear venous space when upgrading to a more complex device system
- Subcutaneous ICD implantation: transvenous leads may need removing when switching to an S-ICD system
How it is performed
Lead extraction is performed in specialist centres with cardiac surgery on standby. Specialised tools including powered sheaths break down fibrous tissue binding the lead to the vein or heart wall, allowing safe removal. The procedure carries a small but recognised risk of serious complications including cardiac tamponade, which is why it is restricted to specialist centres.
Recovery
Hospital stay is typically several days, particularly for infection cases. Re-implantation of a new system may occur at the same time or after antibiotic treatment is complete.
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