What You Need to Know Prior to the Procedure
- We will likely ask you to stop taking certain medications a few days before your procedure (such as blood thinners, clopidogrel, prasugrel, ticagrelor or aspirin). Don’t stop taking any medication before checking with us, however.
- If you need to take medications before the procedure, swallow them with only small sips of water.
- Don’t eat or drink anything after midnight the night before your procedure.
What You Need to Know During the Day of the Procedure
- When you arrive at the hospital you’ll lie on a bed, and your nurse will start an intravenous (IV) line. This line lets our team give you fluids and medications during the procedure. You will also receive an antibiotic prior to the procedure through your IV to help prevent infections.
- It is very important to keep the surgical areas sterile. Your chest and both sides of your groin will be shaved and cleansed with a special soap, and sterile drapes will cover you from your neck to your feet.
- Several devices will be used to monitor your condition (blood pressure, breathing, etc.) throughout the procedure, and you will have a lot of patches and electrodes placed on your skin.
- The procedure will happen in a special surgical room and will be put to sleep by a cardiac specialized anesthesiologist, and will remain asleep throughout the entire procedure. You may be given general anesthesia which will require the use of breathing tube. If you’re uncomfortable when you wake up, be sure to tell the anesthesiologist.
- At that time also you will have a separate line placed in an artery in your wrist to monitor your blood pressure during the procedure, and another IV will be placed in a vein in your groin. This access can be used to:
- Insert a pacemaker wire if necessary to keep your heart in rhythm when your pacemaker is removed
- Insert tools used to remove the leads
- Give you fluids, if needed
- New leads may be placed in your heart (implanted) during this procedure or later. The timing of when your leads are replaced depends on the reason the leads are being removed. If, for example, they are being removed because you have an infection, you’ll be treated for the infection before new leads are implanted.
After the Procedure
- The lead extraction procedure might take 2 to 6 hours to complete. Afterwards, you’ll be transferred to a hospital room as an inpatient, where you’ll stay for 1-2 days.
- Initially, you’ll need to lie flat in bed without moving your legs for several hours after the procedure.
- If a new device and leads are implanted at the time your old leads are removed, then a chest X-ray will be performed immediately after and next day to check your lungs, as well as evaluate the position of any new leads that were implanted, and the device will also be checked to make sure that it is working properly.
- If your device and leads are not replaced at the time of the extraction, you may need be hospitalized until they are implanted. We’ll be able to tell you how long you should expect to be in the hospital and when your new device and leads will be implanted.
- While you’re in the hospital, you’ll be placed on a telemetry monitor. This small box has wires that connect to your chest with sticky electrode patches. The telemetry monitor allows the nurses to observe your heart rate and rhythm on several monitors. They will record this information overnight, and have us review it the following morning.
- If your leads were removed because of infection, then is a possibility that the pocket of the device was left open and packet with gauzes to drain the infection and to slowly heal. This will require close treatment with change of the packing daily. Eventually, a vacuum device will likely be placed over the wound. You will likely receive antibiotics after the procedure, either by mouth or through an IV. These antibiotics may need to be continued at home, and a home healthcare nurse can help if that’s the case.
- No water or other wetness should be allowed at the device site for about a week or until the office visit for wound check.
- We will ask you to come to the office for wound check about a week after the procedure.
- As with any new device implant, we will ask you not to raise the arm on the same side as the device above your shoulder for about a month, or to carry heavy objects during that time.
- If you experience any worsening chest pain or shortness of breath, occurrences of dizziness, syncope or pre-syncope, you should contact our office immediately.
- You should monitor the site closely using a mirror, and call our office if you notice:
- Increased swelling or redness at the excision site or extremity
- Bleeding or drainage
- Fever greater than 101.0 F (38.6 C)
Before you leave the hospital, we’ll talk you about activity limits, medications and follow-up appointments. If you have questions, please ask.