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

Leads may need to be removed for any of the following reasons:

• Damage to the inside or outside of the lead
• Large amounts of scar tissue forming at the tip of the lead
• An infection
• Blockage of the vein by a clot or scar tissue

How does it work?

There are two approaches to lead extraction:

• Subclavian Approach – This is the most common lead extraction method. Leads are extracted through an incision in the upper chest over the subclavian vein.
• Femoral Approach – This approach is used when subclavian is not possible. Leads are removed through a puncture in the groin over the femoral vein.

In either approach, a sheath is placed in the vein, threaded over the lead, and guided to the tip of the lead. The lead is then removed.