Insertion of pacemaker pulse generator only; with existing dual leads
CPT4 code
Name of the Procedure:
Insertion of Pacemaker Pulse Generator Only (with existing dual leads)
Common Name: Pacemaker Replacement
Technical/Medical Term: Pulse Generator Exchange
Summary
This procedure involves replacing the pulse generator of a pacemaker while keeping the existing dual leads in place. It is typically done when the battery of the current pacemaker is depleted.
Purpose
Medical Condition: This procedure addresses patients with bradycardia or heart block who have an existing pacemaker with worn-out batteries.
Goals/Outcomes: The goal is to restore proper heart rhythm and ensure the pacemaker continues to function effectively.
Indications
Symptoms/Conditions: Slow heart rate, dizziness, fatigue, and fainting spells in patients with a previously implanted pacemaker.
Patient Criteria: Individuals with an existing pacemaker that has depleted battery life, confirmed by diagnostic tests.
Preparation
Instructions: Patients may need to fast for 6-8 hours prior to the procedure. They should inform their doctor about all medications and follow any adjustments advised.
Assessments: An electrocardiogram (ECG) and blood tests may be required to evaluate heart function and readiness for the procedure.
Procedure Description
- Anesthesia: Local anesthesia is typically applied to numb the chest area.
- Incision: A small incision is made near the location of the existing pacemaker.
- Removal: The old pulse generator is carefully detached from the dual leads.
- Insertion: The new pulse generator is connected to the existing leads.
- Testing: The new device is tested to ensure it functions correctly.
- Closure: The incision is closed with sutures or adhesives.
Tools/Equipment: Incision tools, new pulse generator, testing equipment.
Anesthesia: Generally, local anesthesia is used; sometimes, sedation may be provided.
Duration
The procedure typically takes about 1-2 hours.
Setting
It is usually performed in a hospital’s surgical suite or a specialized outpatient clinic.
Personnel
A cardiologist or cardiac surgeon will perform the procedure, supported by a team of nurses and a technician specializing in pacemaker technology.
Risks and Complications
Common Risks: Infection at the incision site, bleeding, and bruising.
Rare Risks: Lead dislodgement, device malfunction, and reactions to anesthesia. Management includes antibiotics for infection and potential repositioning of leads if dislodged.
Benefits
Patients can expect their normal heart rhythm to be maintained, preventing symptoms like dizziness and fatigue. Benefits are often realized immediately post-procedure.
Recovery
Post-Procedure Care: Patients are monitored for several hours and may need to stay overnight. Instructions typically include avoiding heavy lifting and strenuous activity for a few weeks.
Recovery Time: Full recovery usually takes about 4-6 weeks. A follow-up appointment will be scheduled to ensure proper healing and device functionality.
Alternatives
Other Treatments: Medications to manage symptoms of bradycardia, implantation of a new pacemaker system instead of just the pulse generator, or lifestyle modifications.
Pros/Cons: Medications may not be as effective for severe cases; new implantation involves more extensive surgery.
Patient Experience
During the Procedure: Patients may feel some pressure or discomfort but generally do not experience pain due to local anesthesia.
After the Procedure: Some soreness at the incision site is expected. Pain management includes prescribed pain relievers and recommendations for reducing activities that could affect the incision.