One of the concerns about a traditional pacemaker is the leads or wires that connect the pulse generator to the heart. While these leads are often well placed in the heart tissue, and should remain there permanently, there is the chance that the leads dislodge or need to be removed at some point during the patient’s life. Of course, if the leads do break or dislodge, the pacemaker will no longer perform its normal duties and the patient will start to experience symptoms similar to prior to the pacemaker implantation. As a result, it is very important that the leads be extracted and reattached to ensure proper pacing.
Why might the leads fail and/or require removal?
- Infection around any part of the leads
- Infection of a heart valve
- Lead breakage, especially in young patients
- Clot formation around the lead
There are two forms of lead extraction – mechanical extraction and laser lead extraction. Below we will discuss both:
Mechanical lead extraction is exactly as it sounds. Removing the leads by pulling them out. While this can work for many patients, some scarring that occurs around the leads may preclude mechanical extraction.
The concerns around mechanical lead extraction led to an advanced lead removal technique load known as laser lead extraction. A laser lead extraction involves the use of high-powered light to cut away the scar tissue from the lead, allowing for the removal of the lead. A laser sheath, which is composed of a tube of laser fiber optics, is placed over the leads, cutting scar tissue around the wire.