Your pacemaker or defibrillator has leads. Leads are insulated wires that run from the inside of your heart to the pacemaker or defibrillator (ICD) battery pack (generator). Over time, your body forms scar tissue around the leads. This helps keep them in place.
You may need a lead extraction procedure to remove the leads. This procedure uses special tools to break up scar tissue and to avoid damaging the heart tissue or blood vessels.
Reasons for an extraction procedure include:
Device or lead(s) is not working as it should.
Device or lead breaks.
Manufacturer recall.
Infection in your bloodstream (bacteremia).
Infection of your heart valve (infective endocarditis).
Abnormal rhythm caused by the lead.
Need to dd or replace lead (device upgrade), but scar tissue interferes with this.
Day Before Surgery
A nurse will call you the day before surgery (or the Friday before a Monday surgery).
The nurse will review your instructions, including medicine holds, and discuss arrival time. Please let your nurse know if you have a contrast dye allergy. If you do not hear from us by 4 pm, please call (608) 263-1530.If you feel sick or have a fever over 101.5°F the day before surgery, call the clinic.
Day of Surgery
An IV will be placed in your hand or arm and blood may be drawn for labs. If needed, areas around the surgical sites will be shaved. Your skin will be cleaned with a special soap. You may receive antibiotics through your IV to help prevent infection.
Your team will determine a sedation (anesthesia) plan to make sure you are comfortable.
Sterile drapes will cover you from the top of your head to over your feet, so that only the
surgical site(s) are exposed. You may have other IVs placed in your arms and/or groin(s).
Your heart’s electrical system and heart function are monitored during the procedure. You may be exposed to some Xray (fluoroscopy).
Your skin will be numbed around the incision site. An incision is made by your previous device site. This is often under the collarbone (clavicle).
Special tools are used to break up scar tissue and free the lead from inside of the heart.
Sometimes the entire lead cannot be removed.
A temporary device may be placed after to help your heart rhythm.
You may need another lead or a new device This may be done the same day. If you have an infection, it will need to be treated before implanting new leads.
What To Expect
You will rest in the recovery area for a few hours. Depending on your recovery, you may go home or stay at the hospital.
After your procedure, you may have:
Soreness or tenderness at the sites that may last 1 week.
Bruising at the site(s) that may take 2-3 weeks to go away.
A small lump (dime to quarter size) at the site(s) which may last up to 6 weeks.
You will receive specific instructions based on whether you receive another pacemaker or
defibrillator.
Pain
You may take a mild pain reliever such as acetaminophen (Tylenol®). Ibuprofen (Motrin®) or other NSAID medicines can increase your risk of bleeding, especially if you are on a blood thinner. Please ask your care team if these medicines are safe for you to take after the procedure.
You may place an ice pack or warm pack over the site for 20 minutes every 2 hours. If the site is wet when you remove the pack, gently wipe the site.
Care of the Puncture Site(s)
It is important that you take care of your sites to prevent an infection. Keep the sites clean and dry for 24 hours.
You may remove the dressing(s) and shower after 24 hours. To care for the puncture site(s):
Gently clean the site for 3 days with soap and water. Pat dry and leave open to air.
Keep the site(s) dry.
Inspect the site daily for redness, swelling, or drainage.
You may feel a small lump (dime to quarter size) under the skin. Most of the time, this goes away within 6 weeks. In some cases, it can persist if scar tissue forms.
Please let us know if you have any new or increasing pain at the site.
Activity
Avoid strenuous activity. Do not lift anything over 10 pounds for 7 days.
Do not soak in a bathtub, hot tub, or go into a swimming pool, lake, or river until the site is completely healed.
After 7 days, you may resume normal activity.
Do not drive for 24 hours, unless told otherwise.
Do not make any important decisions until the next day.
You may have arm restrictions depending on procedure you had done.
Going Home
You may go home the same day or stay in the hospital overnight. We will review discharge
instructions with you.
If you go home the same day, you should have someone drive you home and stay with you overnight.
Heart Healthy Diet
Include heart healthy foods in your diet, such as: vegetables, fruits, nuts, beans, lean meat,
fish, and whole grains. Limit sodium, alcohol, and sugar.
Lifestyle Changes
Do not smoke.
Be active. Try for at least 30 minutes of activity on most days of the week. Talk to your
provider about what type of level of exercise is safe for you.Maintain a healthy weight. Lose weight if you need to.
Manage health problems such as high blood pressure, sleep apnea, high cholesterol, and
diabetes.
Medicines
You will receive instructions for your medicines. If you take or are prescribed a blood thinner,
take this and do not skip any doses. If you take Coumadin (warfarin), you will need to have a
PT/INR level checked. You may need the dose adjusted. This will be done within 3-5 days of
discharge.
Follow Up Visits
This will be arranged after your procedure. Keep your regular follow up visits with the device
clinic.
Return To Work
Talk to your clinician about when it is safe to return to work.
When to Get Emergency Help
Call 911 or go to the nearest emergency room if you have:
Trouble swallowing, or you are coughing up or vomiting blood.
Severe swelling.
New numbness, weakness, or coldness in your extremities (arms, hands, fingers, legs, feet,
toes).Skin turning blue.
Sudden bleeding or swelling at the groin puncture site. If this occurs, apply direct pressure. If the bleeding does not stop after 10 minutes of placing constant pressure on the site, call 911. Keep pressure on the site until help arrives.
Signs of stroke:
Sudden face drooping, arm or leg numbness weakness, confusion.
Trouble seeing, trouble speaking, trouble walking, or severe headache.
When to Call
Call if you have:
Chest pain or new back pain
Increased shortness of breath
Signs of infection around the puncture site, such as-
Redness
Warmth
Swelling
Drainage
A fever over 101.5°F
Trouble urinating
A sudden increase in weight overnight (more than 3 pounds), or over a few days, this could be a sign of fluid retention.
Been prescribed a blood thinner and have questions or concerns about stopping this.
Who To Call
UW Health H art and Vascular Clinic Monday-Friday, 8:00 am – 4:30 pm
608-263-1530
The toll-free number is 1-800-323-8942.
After hours, nights, weekends, and holidays this number will give you the paging operator. Ask for the Cardiology Fellow on call. Give your full name and phone number with the area code. A clinician will call you back.