1. What are lead extraction and device explantation?

The removal of a pacemaker or ICD or CRT lead that was placed in the heart for more than a year is called lead extraction. The removal of the device is called a device explantation.

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2. What are the reasons for lead extraction?

The commonest reason for lead extraction is infection. Sometimes the lead is malfunctioning. This can be due to a break in the lead or loss of insulation. Such malfunctioning leads are best removed if possible and replaced with normal leads.

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3. What is the benefit I will get by having a lead extraction?

An infected lead needs to come out, otherwise, you will suffer from continuous pus drainage from that site. Besides, the infection can spread to other parts of the body like spleen, brain, heart which can be life-threatening.

If the lead is malfunctioning [not infected] then by leaving it inside, it compromises the lumen of the vein. It can lead to venous occlusion causing swelling of the arm. A malfunctioning lead that is not properly secured can migrate in the vascular system [blood vessels] causing complications.

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4. How long will I need to stay in Vellore to get the lead extraction done?

The lead extraction procedure will require 2 days of inpatient stay. However, if you have an infection in your blood then you will need to plan for a prolonged stay [2 to 4 weeks] in Vellore to receive intravenous antibiotics. For patients who are pacemaker dependent, a temporary pacemaker will be inserted during the period of intravenous antibiotics. Once you are free of infection, a new device and lead will be implanted if it is indicated.

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5. What is the cost of a lead extraction?

The cost of a lead extraction depends on the number of tools and gadgets used. Leads that do not come out easily need more complex tools. It can range from Rs 30,000 to Rs. 5,00,000.

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6. Would it hurt me when I undergo the procedure of having a lead [pacemaker wire] extracted and device explanted?

No, it will not hurt you as the procedure will be done under general anesthesia. If the lead was recently implanted, then the procedure may be done under local anesthesia. In that case, it will only hurt as much as a mosquito bite, the moment when the local anesthesia injection is given. After that injection is given, the medicine will act, and you will not have any pain. Sometimes you will feel a pulling or tugging sensation when the doctor tried to remove the lead.

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7. How long will the procedure take?

The procedure will take around 3 to 5 hours which includes a great deal of time that is devoted to doing it in a sterile fashion so as to minimize the risk of infection spread. The time of the procedure is related to how old the leads were, that need to be extracted.

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8. Who will do my procedure?

Your procedure will be done by one of the six consultants in the Cardiac Electrophysiology Unit. They include Dr. David Chase, Dr. John Roshan, Dr. Sirish Chandra Srinath, Dr. Anand, Dr.Hariharan and Dr.Javaid. All of them have vast experience in doing these procedures. If you have been a private patient of one of them then the particular doctor you saw will do your procedure. In case your doctor is unwell and not available, your procedure will be done by one of the other five so as to not keep you waiting.

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9. Will I be awake during the procedure?

You will be asleep during the procedure as it is usually done under general anesthesia. In case the procedure is done under local anesthesia you will feel sleepy due to the medicines given. We will wake you up after it is over.

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10. What are the possible complications? 

The chance of having a complication during or after a lead extraction procedure is directly proportional to the length of time that the leads that have to be extracted were in the body. There is a possibility of cardiac perforation requiring urgent open-heart surgery. The procedure is usually monitored with transesophageal ECHO which helps us identify complications early. Despite having done over 300 lead extractions by God’s grace we have not had any complications so far. 

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11. When can I resume normal activity after the procedure?

You can resume activity equivalent to what it was prior to the procedure within 4-6 hours.

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12. When should I come for my next check-up after the lead extraction?

If the lead extraction was done for an infection you will need to come back for a new lead and device implantation. You may also need to stay on in Vellore to receive antibiotics. Once you leave Vellore after everything is sorted you will need to come back in 3months to a year for follow up.

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