00534 Anesthesia for transvenous insertion or replacement of pacing cardioverter-defibrillator

Name of the Procedure:

Anesthesia for Transvenous Insertion or Replacement of Pacing Cardioverter-Defibrillator (PCD); also known as Implantable Cardioverter-Defibrillator (ICD) insertion.

Summary

This procedure involves the use of anesthesia during the insertion or replacement of a pacing cardioverter-defibrillator through a vein. The device helps monitor and regulate irregular heartbeats.

Purpose

The procedure addresses conditions such as arrhythmias, where the heart beats irregularly. The primary goal is to implant or replace the PCD, which can correct life-threatening irregular heartbeats by delivering electrical pulses or shocks.

Indications

• Patients with a history of ventricular tachycardia or fibrillation.
• Individuals with heart failure and reduced ejection fraction.
• Patients who have survived a sudden cardiac arrest.
• Others at high risk of sudden cardiac death due to heart rhythm abnormalities.

Preparation

• Patients may need to fast (no eating or drinking) for at least 6 hours before the procedure.
• Medication adjustments, particularly blood thinners, as advised by the doctor.
• Pre-procedure diagnostic tests such as ECG, blood tests, and imaging studies.

Procedure Description

1. The patient is placed under local anesthesia with sedation or general anesthesia.
2. A small incision is made near the collarbone.
3. A catheter is inserted through a vein leading to the heart.
4. Electrodes (leads) connected to the PCD are guided through the catheter and positioned in the heart chambers.
5. The PCD device is implanted under the skin, connected to the leads, and the incision is closed.
6. The device is tested to ensure proper functioning.

Duration

The procedure typically takes 1 to 3 hours.

Setting

The procedure is usually performed in a hospital setting, specifically in an electrophysiology lab or cardiac catheterization lab.

Personnel

• Cardiologist or Electrophysiologist
• Anesthesiologist
• Surgical nurses
• Technicians

Risks and Complications

• Common risks include infection, bleeding, and pain at the incision site.
• Rare complications include lead displacement, puncture of the lung (pneumothorax), and device malfunction.
• Complications are managed through medication, additional procedures, or device adjustments.

Benefits

• The primary benefit is the prevention of sudden cardiac death due to fatal arrhythmias.
• Improvement in overall heart function and quality of life.
• Benefits can be realized immediately after successful implantation and device activation.

Recovery

• Immediate post-procedure monitoring in a recovery room or hospital stay for observation.
• Instructions include keeping the incision site clean and dry, avoiding heavy lifting, and adhering to follow-up appointments.
• Recovery time varies but generally ranges from a few days to a couple of weeks.

Alternatives

• Medication therapy for heart rhythm management.
• Other types of implantable devices like a pacemaker.
• Lifestyle changes and ongoing monitoring.
• Each alternative has its pros and cons compared to the PCD, such as effectiveness in preventing sudden cardiac death and long-term management of heart rhythms.

Patient Experience

• During the procedure, patients might experience pressure but should not feel pain due to anesthesia.
• Post-procedure discomfort or mild pain at the incision site is managed with pain relievers.
• Patients might feel tired or sore for a few days but usually resume normal activities relatively quickly with specific activity restrictions.