Arrhythmia Associates LLP

Our Process - Treatment - Laser Extraction of Pacemaker/ICD Leads

Laser Extraction of Pacemaker/ICD Leads

In unusual circumstances, your doctors may decide that the pacemaker/ICD leads need to be removed. This decision is made in the setting of infection or malfunction of the implanted leads or device, which is a rare occurrence. We will generally confer with an infectious disease specialist to make sure that lead extraction is necessary. If it is required, laser extraction is an effective way to remove implanted pacemaker and defibrillator leads when clinically indicated. Lead extraction can become complicated, because scar tissue will often form around the lead, binding it to the lining of the heart and blood vessels. A commercially available transvenous extraction system has been utilized. This system has a "locking stylet", which allows tension to be transmitted to the tip of the lead, and a series of telescoping sheaths, which shear away scar tissue encompassing the lead along its length. In order to be removed, the scar tissue must be separated from the lead and this sometimes requires a specialized laser device to facilitate this process.

Laser extraction uses ultraviolet rays to vaporize scar tissue surrounding the lead. This procedure is less likely to damage or tear the lining or heart and blood vessels. The shearing forces used in this procedure, however, could result in significant complications. We perform this procedure with a cardiothoracic surgeon available and close-by in the event that significant bleeding occurs.

Length of Procedure: 2 - 3 hours

Current Indications for Pacemaker and ICD Lead Removal

Level 1: Septicemia, Endocarditis, Lead Migration, Venous Access, Device Interference

Level 2: Vein Thrombosis, Severe Tricuspid Insufficiency, Pocket Infection, Chronic Draining Sinus, Lead damage needing replacement