Chapter 30: Lead Extraction

Implanted pacemaker and defibrillator leads may occasionally require explantation in order to remove infected hardware or make room for newer leads. The techniques used in accomplishing this task include tools for stabilizing the inner lumen of the lead, cutting sheaths that might also include the use of laser and/or radiofrequency energy, and additional monitoring and the availability of a cardiovascular surgical team (in case immediate thoractomy for a vascular/cardiac repair is required).

It is important to note that lead extraction may result in significant mortality (related to operator experience), vascular and/or cardiac perforation/damage, and retained and/or fragmented/dislodged foreign bodies related to the extraction technique. Lead extraction is not a benign procedure; it requires patience, experience, and the immediate backup of a cardiovascular surgical team. Laser lead extractions are performed at our hospital in the operating room with the immediate availability of a cardiac surgeon.

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