A lead is a special wire that delivers energy from a pacemaker or implantable cardioverter defibrillator (ICD) to the heart muscle. A lead extraction is the removal of one or more leads from inside the heart.

Leads that are placed outside the heart during open heart surgery cannot be removed during this type of procedure.

To prepare:

• ask your doctor what medications you are allowed to take. Your doctor may ask you to stop certain medications one to five days before your test (such as aspirin products). If you are diabetic, ask your doctor how you should adjust your diabetic medications.
• do not eat or drink anything after midnight the evening before your test. If you must take medications, drink only with a sip of water.
• when you come to the hospital, wear comfortable clothes. You will change into a hospital gown for the procedure. Leave all jewelry or valuables at home.
• You will need to stay in the hospital overnight. Bring items with you (such as robe, slippers, and toothbrush) that may make your stay more comfortable. When you are able to return home, arrange for a companion to bring you home.

• You will be given a hospital gown to wear.
• You will lie on a bed and the nurse will start an intravenous (IV) line in your arm so that medications and fluids can be administered during the procedure.
• Your chest and both groins will be shaved and cleansed with an antiseptic solution. Sterile drapes are used to cover you from your neck to your feet to prevent infection. It is important that you keep your arms and hands down at your sides and not disturb the drapes. To remind you, some type of restraint may be used to prevent your hands from coming in contact with the sterile field.
• The nurse will connect you to several monitors.
• You may feel nervous. You will be given a medication through your IV that will make you sleep throughout most of the procedure. Your doctor and nurse will be with you throughout the procedure. If you are uncomfortable or need anything during the procedure, let your nurse know.
• The lead extraction can be performed at two sites:
  • Subclavian vein – most frequently used. An incision is made in the upper chest over the subclavian vein.
  • Femoral vein – used when the subclavian approach cannot be performed. A small puncture (instead of an incision) is made in the groin over the femoral vein.
• The doctor will numb the site. A sheath (plastic, hollow tube) is placed in the vein, and guided to the tip of the lead (where the lead attaches to the heart). The sheath helps to hold the heart muscle in place while removing the lead.
• A laser or special electrosurgical sheath is used to deliver energy to remove scar tissue from the lead. You will be in a light sleep during this part of the procedure. You may feel the pulling as the leads are removed, but you should not feel pain.
• New leads may be implanted (placed in your heart) during this procedure or at a later date. This will depend on the reason your current leads are being removed. Discuss this with your doctor.

• The doctor will remove the sheath.
• You will be admitted to the hospital overnight. You will be placed on a special monitor called telemetry that allows your heart rhythm to be displayed on monitors in the nursing unit.
• If you had new leads and a pacemaker implanted, you will also have a holter monitor to record your heart rhythm for several hours. This is another way to check proper pacemaker function.
• If the femoral approach was used, you will need to lay flat in bed for several hours after the procedure.
• The morning after your lead extraction you will have a chest x-ray to check your lungs and the position of any new leads that may have been implanted.
• Before you leave the hospital, your doctor and nurse will talk to you about activity, medications or any follow-up appointments.

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