Surgical pacemaker lead extraction: 10 years of experience

Due to the worldwide increasing number of patients with pacemaker implants, the problem of lead extraction with its potential difficulties and complications has gained enormous importance. Primarily lead extraction should be attempted percutaneously; however, in case of failure or contraindications for percutaneous extraction, such as vegetations with a high risk of embolization (size >10mm), a surgical approach is necessary.    From 1991 until 2001 we performed surgical lead extraction in 16 patients (mean age 62.1±15.0 years, male 13, female 3). All patients presented with lead infection and clinical symptoms of septicemia at a rather advanced stage, in average 7.0±8.8 months after the onset of symptoms. In 13 cases we performed an open heart approach with the use of cardiopulmonary bypass, in 3 a closed heart approach. Perioperative mortality was 0%. Pacemaker leads were successfully removed in 100%. No reinfections were reported.    Surgical pacemaker lead extraction is a highly effective tool and can be safely performed without significant mortality. If surgery is indicated it should be performed as early as possible.