Implantable Cardiac Device Lead Management and Extraction

The experts on our team are trained and practiced in managing implantable cardiac devices. These small, battery-powered devices include:

Most of these complex devices are made up of 2 main parts:

  • A generator, which includes the device’s battery
  • Wires (also called “leads”), which connect the device to the heart

Leads can monitor the heart rhythm and deliver energy to the heart for pacing. In some cases, leads can shock the heart back to normal rhythm. In most cases, leads stay permanently attached to the heart for a lifetime.

When leads are not working properly, our team can perform advanced troubleshooting, often with non-surgical methods. If necessary, lead problems can be addressed by repositioning or replacing the lead. Sometimes this requires that we remove (extract) an old lead.

What is lead extraction?

In some cases, it may be necessary or preferred to remove leads by a surgical procedure called lead extraction. Extraction might be needed when a lead malfunctions, becomes unnecessary, or gets infected. A lead's lifespan depends on what type of lead it is and how much it is stressed in the body, but leads usually last 20 to 30 years.

Historically, lead extraction was avoided unless absolutely necessary because of the high risks of the procedure. Now, thanks to major advancements in tools and techniques, we can safely remove leads when necessary. Our best-in-class, local care allows you to stay close to home here in northern New England and get back to doing the things you love.

When a lead malfunctions, you may experience:

  • Fatigue (extreme tiredness)
  • Loss of exercise tolerance
  • Shortness of breath
  • Passing out or near passing out
  • Inappropriate shocks from a device with shocking capability (for example, an implantable defibrillator)
  • The device's battery losing power faster than expected

In many cases, you may have no symptoms if a lead malfunctions. If your device is monitored via remote monitoring, problems will likely be detected before symptoms develop.

When a device or lead becomes infected, you may experience:

  • New pain or discomfort near the generator pocket (where the device is implanted under the skin)
  • New redness, swelling, or wrinkling of the skin over the device
  • Unexplained fevers, night sweats, body aches, or malaise (a general feeling of discomfort)

If you’re experiencing these symptoms, call your cardiologist.

Our team

Our team is made up of electrophysiologists, advanced practice practitioners (APPs), and cardiac nurse specialists. We support a large system of rural hospitals and bring a long history of medical excellence and academic rigor.

If you are referred to us, you will meet with one of our experts in lead management and extraction: Emily P. Zeitler, MD, MHS and Evan K. Grove, MD, MHS.

Meet the Cardiac Electrophysiology team

What to expect if you need to consider a lead extraction procedure

We perform all lead extractions in one of our state-of-the-art cardiac electrophysiology (EP) labs in Lebanon, New Hampshire. Our EP labs are centrally located, with plenty of parking and amenities close by to make your trip easy and worry free.

If you need to have the lead on your implanted cardiac device removed, you can expect to:

  1. Speak with your primary cardiologist first. Your cardiologist is your best resource for understanding what to expect and why you need this care. They will refer you to a trusted electrophysiologist for a consultation.
  2. Meet with one of our electrophysiology doctors who has expertise in lead troubleshooting and lead extraction.
  3. If you are a candidate for lead extraction, you will probably undergo a special CT (computed tomography) scan of your chest and heart in preparation for the procedure.
  4. Work with our team to schedule your surgery.

Your lead extraction procedure will be done under general anesthesia, performed by specially trained cardiac anesthesiologists. Most patients stay 1 night in the hospital for monitoring after the procedure.

After your lead extraction surgery, your primary cardiologist will resume your care.

For referring providers

To arrange an outpatient lead management consultation, call the EP scheduling team at 603-650-4590.

Urgent transfers for patients with actively infected devices should go through the DHMC Transfer Center and will be facilitated by the lead management team.

Current research on lead management and extraction