A pacemaker lead is a wire that carries signals from an artificial pacemaker to the heart. The number of leads a surgeon implants with a pacemaker depends on the type of pacing a patient needs. For a biventricular pacemaker, for example, there will be three pacemaker leads. The leads remain in place unless a problem develops and the surgeon needs to replace them to correct an issue like infection, inflammation, or pacemaker malfunction.
When a patient's heart is beating abnormally, a doctor may provide temporary pacing using an external pacemaker. In this situation, the doctor threads leads through the patient's blood vessels to the heart. Patients with temporary heart problems often have limited mobility and are unlikely to pull out the leads by accident. When a patient's heart problem appears permanent in nature, the doctor will recommend internal pacing, where a pacemaker is implanted in the chest and connected to the heart with leads.
Each pacemaker lead can be fixed, screwed, or hooked into the heart to keep it in place, or simply positioned to allow the heart muscle to absorb a sharp tip. Insulation and other features on the leads vary, and some come packed with steroids to prevent inflammation once the lead is in place. All are sterile and made from nonreactive materials to limit the chance of an adverse reaction to a pacemaker lead.
Pacemaker and lead insertion requires anesthesia, as otherwise the procedure would be uncomfortable and painful. Once the device is in place, the doctor will test it to confirm that it works, and then bring the patient out of anesthesia. Patients need periodic follow-up appointments to monitor pacemaker function and determine when the battery needs to be replaced. They may also need a pacemaker lead replacement, depending on how long the device has been in place and how well the patient tolerates it.
Patients using pacemakers for heart rhythm receive a pacemaker card with information about the device and its type. It is important to carry this card, as it can provide critical information for health care providers. Patients who experience a problem with a pacemaker lead should make sure it is noted on the chart, as this could become an issue. For instance, a doctor may leave a lead in place after disconnecting it because it cannot safely be removed, and other care providers would need to know about this if they perform surgery or treat the patient for a heart problem.
