Laser Lead Extraction Procedure
The laser lead extraction procedure takes two to four hours. You will be asleep during the procedure. The heart-lung bypass machine is not needed during the procedure.
The doctor first makes a 5-centimeter incision on the left side of the chest, usually in the same place where your pacemaker/ICD incision was made.
Through this incision, the doctor removes the battery from your pacemaker/ICD and disconnects it from the lead.
Then, the surgeon places a sheath, or tube, inside the vein and over the lead that needs to be removed. The surgeon guides this sheath down to the tip of the lead, where it attaches to the heart (see Figure 1 below). The sheath helps stabilize the heart muscle while the lead is removed.
The sheath is attached to a laser. The laser delivers energy to remove the scar tissue around the tip of the lead. This detaches the lead from the inside of the vein (see Figure 2 below).
After the scar tissue is removed, the doctor gently removes the lead from the heart and vein. The doctor then removes the laser and sheath (see Figure 3 below).
The doctor may then implant a new lead and/or a new pacemaker/ICD right away, or this may be done at a later date. This depends on the reasons for having the lead extraction in the first place. If there was an infection at the lead site, it is preferable to wait until the infection heals before placing new leads. Your doctor will recommend the appropriate course of treatment for your specific situation.
After the procedure is complete, the doctor then closes the incision and applies bandages to the incision site.