Perhaps most important, Medtronic isn't recommending that the leads be taken out unless they are actually fractured. And cardiologists overwhelmingly agree with that advice. Surgical removal of a lead is potentially deadly itself. The lead sits in the patient's vein. Scar tissue forms there and at the point in the heart where the lead attaches. So extracting it can trigger bleeding, which can be lethal.What most agree, again, is that if a patient does not have an actual fracture, that leaving the lead alone is probably the most prudent advice and to continue close monitoring. Every time a device pocket is opened to revise the system, there is also a small but real risk of infecting the defibrillator system.
If a lead is found to be fractured, patients may have a choice of intervention. Doctors differ as to whether lead extraction or adding a new lead threaded through the same vein is a better approach. But many patients will have to have it extracted because there isn't room for a new lead in the vein.
Should a lead become fractured and the defibrillator system require revision, however, one other option exists that was not mentioned in the WSJ article: a new lead (or even a new system), could be implanted from the contralateral (opposite) arm. In some cases of lead fracture, this might be the safest route to take.