33214 Upgrade of implanted pacemaker system, conversion of single chamber system to dual chamber system (includes removal of previously placed pulse generator, testing of existing lead, insertion of new lead, insertion of new pulse generator)

Name of the Procedure:

Upgrade of implanted pacemaker system, conversion of single chamber system to dual chamber system

Summary

The procedure involves upgrading a single chamber pacemaker to a dual chamber system. This includes removing the old pulse generator, testing the existing lead, inserting a new lead, and installing a new dual chamber pulse generator.

Purpose

The procedure is designed to improve the regulation of heart rhythms in patients with certain cardiac conditions. The goal is to enhance the synchronization between the upper and lower chambers of the heart, leading to better overall heart function and improved quality of life.

Indications

• Symptomatic bradycardia (slow heart rate) despite optimal medication
• Heart block (signal disruption between heart chambers)
• Sick sinus syndrome (improper heart rate regulation)
• Previously implanted single chamber pacemaker no longer meeting patient’s needs

Preparation

• Patients may be required to fast for a specified period before the procedure.
• Certain medications, especially blood thinners, might need to be adjusted.
• Pre-operative tests such as an EKG, blood work, and imaging studies of the heart and pacemaker system are performed.

Procedure Description

1. Local anesthesia is applied along with sedation as needed.
2. An incision is made at the site of the existing pacemaker.
3. The existing pulse generator is carefully removed.
4. The current lead is tested to ensure its functionality.
5. A new lead is inserted through a vein into the heart and positioned correctly in the second chamber.
6. The new dual chamber pulse generator is then connected to both leads.
7. The incision is closed with sutures, and the new device is programmed to suit the patient’s requirements.

Duration

The procedure typically takes about 2 to 3 hours.

Setting

The procedure is usually performed in a hospital or a specialized surgical center.

Personnel

• Cardiologist or cardiac surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurses
• Cardiac technician

Risks and Complications

• Infection at the incision site
• Bleeding or bruising
• Lead displacement requiring repositioning
• Device malfunction or failure
• Possible complications from anesthesia
• Rare risk of damage to the heart or blood vessels

Benefits

• Improved heart function and symptom relief.
• Better synchronization between heart chambers.
• Enhanced overall quality of life.
• Increased longevity of the pacemaker system.

Recovery

• Patients are usually monitored for a day or two in the hospital.
• Instructions include keeping the incision site clean and dry.
• Avoid heavy lifting and strenuous activities for several weeks.
• Follow-up appointments to monitor pacemaker function and wound healing.

Alternatives

• Continued use of a single chamber pacemaker with medication adjustments.
• Possible use of alternative cardiac devices like biventricular pacemaker.
• Each alternative depends on specific patient conditions and needs, often providing less comprehensive benefits compared to the dual chamber system.

Patient Experience

Patients may experience mild discomfort and soreness at the incision site post-procedure. Pain is managed with prescribed medications. Most patients notice an improvement in symptoms shortly after the procedure and can return to normal activities within a few weeks, adhering to their doctor’s recovery guidelines.