33211 Insertion or replacement of temporary transvenous dual chamber pacing electrodes (separate procedure)

Name of the Procedure:

Insertion or replacement of temporary transvenous dual chamber pacing electrodes (separate procedure)

Summary

In layman's terms, this procedure involves placing or replacing temporary wires inside a patient's veins to help control heartbeats. These wires connect to an external device that helps regulate the heart's rhythm until a more permanent solution can be found.

Purpose

This procedure is used to manage conditions that cause abnormal heart rhythms, such as arrhythmias. The goal is to ensure the heart beats correctly until a permanent pacemaker can be implanted or the underlying issue is resolved.

Indications

• Severe bradycardia (slow heart rate)
• Heart block (interruption in the heart's electrical signaling)
• Atrial fibrillation with slow ventricular response
• Recovery from certain cardiac surgeries
• Temporary pacing needed during diagnostic tests or treatments

Preparation

• Patients may need to fast for a few hours before the procedure.
• Certain medications might need to be adjusted or temporarily stopped.
• Pre-procedure tests, such as an ECG (electrocardiogram), blood tests, or imaging studies, may be required to assess heart function and general health.

Procedure Description

1. The patient is typically given a mild sedative and a local anesthetic at the site of insertion.
2. A small incision is made, usually in the upper chest or neck area.
3. A catheter containing the pacing wires (electrodes) is threaded through a vein to the heart.
4. The position of the electrodes is confirmed using fluoroscopy (a type of live X-ray).
5. Once in place, the electrodes are connected to an external pacemaker device.
6. The external device is programmed to regulate the heart's rhythm.
7. The incision site is closed with stitches or surgical glue.

Duration

The procedure typically takes about 30 minutes to 1 hour.

Setting

The procedure is usually performed in a hospital setting, either in a specialized cardiac catheterization lab or an operating room.

Personnel

• Cardiologist or Electrophysiologist
• Cardiac Nurses
• Radiology Technicians
• Anesthesiologist or Nurse Anesthetist

Risks and Complications

• Infection at the insertion site
• Bleeding or bruising
• Blood clots
• Perforation of the heart or blood vessel
• Dislodgment of the pacing electrodes
• Pneumothorax (collapsed lung)

Benefits

• Stabilizes heart rhythms temporarily
• Improves symptoms associated with abnormal heart rhythms, such as dizziness, fatigue, or fainting
• Provides a bridge to more permanent treatments like implantation of a permanent pacemaker

Recovery

• Patients may need to stay in the hospital for monitoring for a short period.
• The insertion site should be kept clean and dry.
• Follow-up appointments are necessary to check the function of the pacing electrodes.
• Most patients resume normal activities within a few days, but strenuous activities may be restricted.

Alternatives

• Permanent pacemaker implantation if immediate and long-term pacing is required.
• Medications to manage heart rate and rhythm.
• Catheter ablation for certain types of arrhythmias.
• External (transcutaneous) pacing, though it is usually less comfortable and less efficient.

Patient Experience

During the procedure, the patient might feel some pressure or discomfort at the insertion site. After the procedure, there may be minor pain or tenderness where the incision was made. Pain management measures, such as prescribed pain relief medications and comfort measures like ice packs, are typically used to improve the patient’s comfort.