Cardiac Lead Extraction
Pacemakers and Defibrillators have fine wires (leads) leading from the battery (generator) to the heart muscle. Sometimes these leads need to be removed and replaced. The most common reasons for lead removal are failure of the lead (often a crack) or infection of the lead. Leads are removed in the Operating Room with a laser-guided sheath by a highly specialized surgical team. At St. Paul’s Hospital the surgeons that perform the Lead Extractions are Dr. Jamil Bashir and Dr. Shahzad Karim.
What to Expect if You are Having a Lead Extraction Procedure
If you do not have an infection:
You will attend the Pre-Assessment Clinic at St. Paul’s Hospital approximately 2 days before your surgical procedure. This visit prepares you for surgery. You will have a chest x-ray, blood work, and a nurse and an anesthetist will do an assessment and ask you questions about your health.
The morning of your procedure you will be admitted to the Surgical Day Care Unit on the 3rd floor. There the nurses will prepare you for surgery. Just before surgery a nurse will put an intravenous (IV) into your arm and start antibiotics through the IV.
After the leads are removed, the surgeon will implant a new pacemaker or defibrillator and new leads, during the same operation. After the procedure you will recover in the Cardiac Surgery ICU. The next day you will be transferred to the Cardiac Surgery Unit (5B), usually for just one more night of observation.
If you do have an infection:
Before your surgery you will see an Infectious Diseases Specialist. You may have blood tests done to see what is causing the infection. You may also have an Echocardiogram (ultrasound of your heart).
You will attend the Pre-Assessment Clinic at St. Paul’s Hospital approximately 2 days before your surgery. At the clinic you will have a chest x-ray, blood work, a nurse and an anesthetist will examine you and ask you questions about your health.
The morning of your procedure you will be admitted to the Surgical Day Care Unit on the 3rd floor. There, the nurses will prepare you for surgery. Just before surgery, the nurse will put an intravenous (IV) into your arm and give you antibiotics through the IV.
The surgeon will remove the pacemaker or defibrillator and the leads. He will not replace the pacemaker or defibrillator at this time, to allow the antibiotics to fight the infection first. Therefore, you may need a temporary pacemaker (with the battery outside your body) or an infusion of a medication to stimulate your heart until your new pacemaker is inserted.
After surgery you will recover in the Cardiac Surgery ICU for 1-2 days. You may also require a few days of monitoring of your heart rhythm in the Coronary Care Unit. You will continue on IV antibiotics and possibly other drugs to stimulate your heart rate. As you will likely need 4-6 weeks of antibiotics, a special IV (PICC) will be inserted. This is often done in the X-Ray department. PICC lines are used for long-term intravenous infusions.
You will get your new pacemaker or defibrillator approximately 5 days after your original surgery.
Most patients will be need 4 – 6 weeks of intravenous antibiotics after they go home. You will receive teaching on how to manage the IV antibiotics at home. The target discharge date is one week after the original surgery.