Lead Removal

Hi All,

Love the website! Pretty soon I'll be going under to replace my current model ( Medtronic ) which entered VVI mode back on January 22nd. Since then, my heart has been pacing around 65 bpm and doesn't really deviate from that. This is going to be my 4th device and its not so much the device replacement that bothers me, its my one lead.

The two leads are currently 15 (replaced when I was 10) and 22 (implanted during my original procedure) years old. Since I've been in VVI mode for a little over 2 months, they want to replace the device this Friday.However, I received a call from my electrophysiologist last Friday basically saying he wasn't confident in the removal of 22 year old lead and I would most likely need to see a specialist. I have an appointment to confirm this but he said this is most likely the situation.

Looking over other posts, it seems that this may cause the procedure to become something more than I assumed. Due to the advanced age of the one lead, whats the process in removing it? Is there a larger margin of error involved in something like this due to the older age of the lead and would it cause other issues?

Thanks,
Sean

4 Comments

Hi Sean........

by Tattoo Man - 2015-03-30 07:03:40


.....................get someone who really knows what they are doing....mine went just fine...

Consider a General Anaesthetic

Tattoo Man

Lead removal

by golden_snitch - 2015-03-30 08:03:01

Hi Sean!

Lead removal is indeed a bit tricky and risky. The longer the lead has been in, the more difficult it is to take it out. There is scar tissue around the tip of the lead, and when you try to pull the lead out, there is a risk that you tear a hole in the heart wall. So, it's good that your doctor is referring you to a specialist who has experience with this procedure.

For leads that have been in for many years, one uses a laser sheath to remove leads. It's a normal pacemaker surgery, though, not more invasive. They disconnect the old lead, then place that laser sheath over it which goes all the way down to the heart muscle, and then the laser is activated to carefully remove the scar tissue around the tip of the lead. BUT it does not always work, and in any case there always needs to be a surgical team on stand-by. That's why this procedure should only be performed in hospitals that have a cardio-thoracic surgery department.

Here's a good explanation of how it's done:
http://www.uwhealth.org/heart-cardiovascular/laser-lead-extraction-procedure/11125

If a lead really needs to be removed, but the laser procedure does not work, more invasive surgery is required, and that means open-heart surgery.

But with just two leads in at the moment, one might in your case just add a third lead, and not go for the big surgery. That's an option, too. Usually, 3-4 leads are okay, one starts removing leads when you already have, for instance, two or three bad ones in, and need new ones.

Best wishes!

leads

by Tracey_E - 2015-03-30 08:03:42

So, you have two leads now and one needs replaced? Or is it working and he wants to replace it due to age? First thought, if it ain't broke, don't fix it. Average lead life is 15-20 years but they can last many years past that.

When I was in this situation a few years ago, I had a venogram (iv with dye done in cath lab) to see how much space was in the vein. The first dr I saw wanted to try to fit another lead and if that didn't work his comment was "we'll deal with it." I found another dr! No way was I going under anesthesia without a clear plan. I had room so we capped off the broken one and added a new one. I won't get away with that again, next time we'll have to extract and start over. I'm young enough that I fully expect to outlive these leads so I wanted to put off extraction as long as possible so hopefully I'll only need it once.

If you need an extraction, you definitely want a specialist, ideally someone who does at least 100 per year. They use a laser sheath to, mm by mm, remove the old lead from the scar tissue. The lasers have come a long way in the last few years and there are more experienced surgeons than there used to be, so the complication rates are much lower.

My guess is they would remove both leads if they are extracting, not just one.

Lasers!

by hankscorpio15201 - 2015-03-30 09:03:42

Hi all,

Thank you for the information. I have a veniogram scheduled for Wednesday so I'll have a better answer then. Also laser sheath sounds pretty cool, so futuristic.

Thanks again,
Sean

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