The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on laser sheath removal of pacing leads.


This procedure is used to remove pacemaker leads that have been in place for more than a few months.

A pacemaker is a device inserted to maintain the rhythm of the heart. During insertion, one or more leads are passed through the veins into the right side of the heart with their other ends are attached to the pacemaker, which is usually placed under the skin of the chest.

Pacemaker leads may need to be removed or changed if they malfunction or become infected. If the leads have been in place for more than a few months, they can become tightly attached by scar tissue to the heart and the veins they pass through, making removal difficult and risky.

Laser assisted removal of pacing leads is claimed to be quicker and less risky than other methods. It involves passing a double layered sheath over the pacing lead, starting with the end that lies outside the body. The inner layer of the sheath is fibreoptic and can transmit a laser beam. The outer layer is more rigid. The double sheath is passed slowly down over the lead while the laser destroys the scar tissue as the sheath advances. Near the heart wall, the more rigid outer sheath is advanced to provide countertraction for removal of the pacing lead.

The procedure is generally carried out under X-ray control. It may take several hours.

Coding and clinical classification codes for this guidance.