Our Nuts and Bolts in The Permanent Pacemakers’ Explanation Techniques


  • Shahab Saidullah Assistant Professor of Cardiology ,PIMS hospital ,Islamabad
  • Bakhtawar Shah Principal Medical Officer, Hayatabad Medical Centre ,Peshawar
  • Salman Habib Post-Graduate Resident, Department of Cardiology, PIMS Hospital, Islamabad
  • Asma Rauf Consultant Cardiologist, Bilal Hospital, Rawalpindi


Permanent pacemakers, explantation techniques, Temporary pacemaker , internal jugular vein , femoral vein



Explantation like implantation of devices is an art. Box change may be needed alone or it may accompany by lead extraction. If it is just box change then the strategy from very start is different to make it as simple as possible but if lead extraction is part of the procedure then it should be planned differently before incision to shorten the procedure time and minimize the complication rate. For successful explantation if the role of gadgets and expertise cannot be subvert, then at the same time a well-planned procedure cannot be undermine. We are going to share our experience of device explantation in the last one decade at Hayat Abad Medical Complex Peshawar.

Methodology: All patients who presented for box change or explantation of devices were prepared with standard protocol. After baseline patient were brought nil by mouth to catheterization laboratory (Cath: lab). Temporary pacemaker (TPM) implanted for backup.  After local anesthesia, with blunt dissection the device recovered and detached from the lead. In case of box change new device attached after checking the integrity of the lead and device placed in the same pocket. But if there was need of lead extraction, then stylet put inside the lead and with twisting movement and mild traction the lead removed and new lead implanted with Seldinger,s technique, battery attached and wound closed in layers.

Results:  Total   1670 were performed during the study period. There were 1535 (91.9%) new implantation and 135 (8.08%) repeat procedures. Pulse generator was replaced without lead replacement in 59 (3.5%) patients. In 36 (2.15%) patients the ventricular lead or atrial lead was successfully reposition. Total 32 (1.9%) successful explanations were performed in the study period.

Conclusion: Explanation for box change and lead extraction needs to be individualized and the whole procedure needs to be planned before instead as a default or provisional procedure for both together.






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