33212 Insertion of pacemaker pulse generator only; with existing single lead

Name of the Procedure:

Insertion of Pacemaker Pulse Generator Only; with Existing Single Lead

• Common Names: Pacemaker Replacement, Pacemaker Generator Change

Summary

This procedure involves implanting a new pacemaker pulse generator while using an existing single lead. The pulse generator is the device that regulates the heart's rhythm by sending electrical impulses.

Purpose

The procedure is done to replace a malfunctioning or depleted pacemaker pulse generator. It aims to restore normal heart rhythm and function, thereby alleviating symptoms like fatigue, dizziness, or fainting spells caused by irregular heartbeats.

Indications

• Symptoms such as fatigue, dizziness, or syncope (fainting).
• Evidence of pacemaker battery depletion or malfunction.
• Preexisting single lead that is functioning correctly and does not need replacement.

Preparation

• Fast for at least 6-8 hours before the procedure.
• Adjust or temporarily discontinue certain medications, as guided by the healthcare provider.
• Perform diagnostic tests like ECG, blood tests, and imaging studies to confirm the condition.

Procedure Description

1. The patient is placed under local anesthesia, sometimes combined with sedation.
2. An incision is made near the old pacemaker site, usually under the collarbone.
3. The malfunctioning or depleted pulse generator is removed.
4. The existing lead is assessed for functionality.
5. The new pulse generator is connected to the existing lead.
6. The device is tested to ensure it works correctly.
7. The incision is closed with sutures or staples, and a dressing is applied.

Duration

Approximately 1-2 hours.

Setting

Typically performed in a hospital's operating room or a specialized outpatient cardiac procedure center.

Personnel

• Cardiologist or Cardiothoracic Surgeon
• Anesthesiologist or Nurse Anesthetist
• Surgical Nurses and Technicians

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma formation
• Lead dislodgment or malfunction
• Pain or discomfort at the generator site
• Rarely, pneumothorax (collapsed lung) or damage to blood vessels

Benefits

• Relief from symptoms caused by bradycardia or heart block.
• Improved quality of life and increased energy levels.
• Immediate improvement typically noticed, although full benefits might become evident over days to weeks.

Recovery

• Keep the incision site clean and dry.
• Avoid strenuous activity or lifting heavy objects for several weeks.
• Follow-up appointments to monitor pacemaker function and wound healing.
• Pain management with over-the-counter or prescribed medications.
• Most patients resume normal activities within a few weeks.

Alternatives

• Continued monitoring without replacement (not ideal if the pacemaker is critical).
• Medication adjustments to manage heart rhythm (may not be as effective as a pacemaker).
• Other advanced cardiac devices if required.

Patient Experience

• Mild discomfort or pressure during the local anesthesia injection.
• Post-procedure soreness or bruising at the incision site.
• Instructions on pain management, wound care, and activity restrictions provided.
• Most patients report significant improvement in symptoms within a few days to weeks.