University of Wisconsin Cardiovascular Surgery: Laser Lead Extraction

Laser Lead Extraction

A cardiac lead is the wire that connects a pacemaker or implantable cardioverter defibrillator (ICD) to the heart (Figure 1). The lead delivers energy from the pacemaker or ICD directly to the heart muscle. These devices are used to help patients maintain a normal heart rhythm.

Figure 1: Cardiac Lead connected to pacemaker or ICD

If a cardiac lead or pacemaker is infected, or not working properly, it may need to be extracted (Figure 2).

Figure 2: Positioning of cardiac lead to be removed

Reasons for lead extraction include:

Damage to the lead itself
A buildup of scar tissue at the end of the lead, where in comes in contact with the inside of the heart. This may cause the lead to need more energy than the pacemaker or ICD can deliver (an “exit block”)
An infection where the lead or pacemaker is implanted in the heart
Interference between the lead and blood flow back to the heart
Interference between the lead and other leads

In the past, lead extraction surgery involved placing a counterweight on the lead and gradually pulling it out. This often resulted in the lead breaking or damage to the surrounding heart tissue.

UW Health surgeons and cardiologists now perform lead extraction surgery using special catheter-guided lasers. This new technique uses cold, controlled laser energy to free the lead from surrounding scar tissue (Figure 3). This lets the doctor safely remove the lead with little risk of damaging the heart.

Figure 3: Scar tissue around the cardiac lead