As cardiac devices improve and need to be replaced, leads left behind in the patient's body could lead to critical illnesses caused by infections.
As millions of people have gotten implanted cardiac devices, and those devices keep improving, many leads on currently implanted devices will need to be removed at some point for various reasons, such as the formation of a clot or scar tissue blocking the vein, or the formation of scar tissue around the tip so that it needs more energy to function than the device can deliver.
Electrophysiologist Jude Clancy, MD, of the Lead Management Program at Yale University, is on a mission to increase awareness about the potential dangers of cardiac device leads that are left behind, including critical illnesses caused by infections around old leads.
Old leads are often left behind when patients receive successor devices, and Clancy has seen patients with as many as 8 old leads abandoned in their bodies when new devices were implanted. Often, no one realizes the leads could be a problem until the patient notices severe redness and swelling in the implantation area, or the device literally erodes through the skin, he explains.
“Most infections come in urgently, in the emergency room,” Clancy said in a statement. “When you look back, the patient has usually been to the emergency room multiple times before they’re admitted.”
Patients should visit the lead management clinic for an evaluation, discussion, echocardiogram, and other tests before a problem becomes serious. Lead extraction surgery, if recommended, may be a simple 2-hour procedure that pulls the lead out. However, if scar tissue has formed, then removal can be a painstaking, delicate procedure taking up to 8 hours to perform. Surgeons may extract the lead through an incision in the upper chest or through a small puncture in the groin.
Yale reports performing 100 lead extractions in the past year with no mortality and a 98% success rate.