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Laser Lead Extraction

Occasionally, pacemaker and implantable cardioverter defibrillator systems need to be removed. One part of the system is the pulse generator, a metal can that contains electric circuits and a battery, usually placed under the skin on the chest wall beneath the collarbone. The other parts are the wires, or leads, which run between the pulse generator and the heart.

The pulse generator can be removed relatively easily because it is contained in the chest wall pocket and can be reached through a surgical incision. The leads, however, run a long course through the veins into the heart. The leads are removed from the inside of the heart by use of specialized tools, such as the laser sheath. The laser sheath is a flexible tube, made of stainless steel or plastic, that passes over the lead, surrounding it and freeing it from the body by disrupting scar tissue as it is advanced toward the heart.

Power sheaths, the latest technology for lead extraction, deliver energy to the tip of the sheath. As the sheath is pushed over the lead and comes to an area of attachment, the operator can turn on the sheath’s energy source to heat or vaporize scar tissue. This has the effect of cutting the lead from its attachments, allowing the lead to be removed with much less force. Once the entire lead is freed from scar tissue, it can be pulled out of the body safely.

Usually, the lead-extraction procedure is performed under general anesthesia, but sometimes, sedating medications may be used instead. Lead extractions usually take between 2 and 6 hours, and patients are usually admitted to the hospital overnight. Certain medications, such as blood thinners, might be stopped before the procedure. If the patient needs a new cardiac device and leads, these may be implanted at the same time as the lead extraction or on a different day.

Previous Page Last Review Date: January 8, 2018