Pacemaker Lead Extraction

What is Lead Extraction?

Pacemaker removal may be necessary due to fractures or breaks in the cables, malfunctions in the battery or infections. The removal of the battery and wiring is called pacemaker removal or extraction. It is a procedure that requires a high level of experience.

How is a pacemaker lead extraction done?

Pacemakers are extracted by non-surgical method or sometimes by surgery. After the pacemaker is implanted, as time passes, the leads adhere to the vascular tissues or inside the heart.

If the person is pacemaker dependent, a temporary pacemaker is inserted before extraction. Then the pacemaker pocket is opened and the battery is extracted from the pocket. The leads in the pocket are released. If there are screws at the end of the leads that provide connection to the heart, they are closed. If the leads have been in place for a relatively short time, they can be extracted by simple retraction.

In pacemaker that have been installed a long time ago, both adhesions increase and the durability of the leads deteriorates over time. For this reason, a special wire is sent through the central groove in the lead so that it does not break off during the procedure. A mechanical extractor system is then advanced over the pacemaker lead.

This “mechanical extractor” has small cutters at the ends. When the trigger of the mechanical extractor is pressed, the cutters rotate and move forwards, disengage the lead from the adhesions and then re-engage. This delicate process is continued along the lead all the way to the heart. When the separation from the surrounding tissues is complete, the lead is pulled back and extracted.

The lead is attached to the heart at the end and must be gently disconnected at this point. The extraction of the pacemaker requires a high level of experience.

The pacemaker can also be extracted by accessing the leg veins. With various catheters and a lasso system, the leads can be grasped and extracted. You can read our scientific article on this subject here.

You can watch some of our pacemaker extraction procedures in these videos.

Why do you need lead extraction?

The most important reason is breakage and deterioration of the pacemaker leads. Infections are also important reasons.

What are the Risks of Pacemaker Extraction Surgery?

Vascular injury may occur while releasing the leads or injury to the heart while separating it from the place where it is held in the heart. It may pose a risk to life and may require emergency surgery. The rate of these important complications is around 1-4% in the literature.

What is the recovery time for pacemaker lead extraction?

The process after pacemaker extraction is personalised. Depending on the reason for pacemaker extraction, the condition of the pacemaker pocket, whether the person is dependent on the pacemaker or not, and what the actual disease in the heart is, individualised approaches should be taken.

Pacemaker lead extraction
Pacemaker lead extraction

You can watch my posts about pacemaker removal on my Instagram account by clicking the buttons below.

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Picture of Prof. Dr. Taylan Akgün
Prof. Dr. Taylan Akgün

He is a cardiologist specialised in the diagnosis and treatment of heart rhythm problems (ablation), pacemaker procedures.
He works in Istanbul province.

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