33224 Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or implantable defibrillator pulse generator (including revision of pocket, removal, insertion, and/or replacement of existin

Name of the Procedure:

Insertion of Pacing Electrode, Cardiac Venous System, for Left Ventricular Pacing (also known as Cardiac Resynchronization Therapy or CRT)

Summary

This procedure involves placing a pacing electrode in the cardiac venous system to improve the heart's function. It is often attached to an existing pacemaker or implantable defibrillator. The process may also include revising the pocket where the device is housed, and removing, inserting, or replacing existing components.

Purpose

This procedure addresses heart failure and certain types of arrhythmias by improving the coordination of the heart’s contractions. The goal is to enhance the function of the left ventricle, leading to better blood flow and reduced symptoms of heart failure.

Indications

• Heart failure with reduced ejection fraction
• Bundle branch block or other conduction disorders
• Patients with poor response to standard pacemakers or defibrillators
• Symptoms like fatigue, breathlessness, and edema due to heart failure

Preparation

• Fasting for at least 6-8 hours before the procedure
• Temporary discontinuation or adjustment of certain medications
• Pre-procedure assessments like an ECG, blood tests, and imaging studies

Procedure Description

1. The patient is given local anesthesia and mild sedation.
2. An incision is made near the collarbone to access the existing device pocket.
3. The pocket is revised if necessary, and the new pacing electrode is guided through a vein to the heart’s left ventricle.
4. The electrode is attached to the previous pacemaker or defibrillator.
5. The position and effectiveness of the electrode are tested.
6. The incision is closed and bandaged.

Duration

The procedure typically takes 2-3 hours.

Setting

The procedure is performed in a hospital, specifically in a cardiac catheterization lab or an operating room.

Personnel

• Cardiologist or cardiac surgeon
• Nurses
• Anesthesiologist or sedation specialist
• Radiologic technologist

Risks and Complications

• Infection at the incision site
• Bleeding or bruising
• Puncture of the lung or heart muscle
• Lead dislodgment or malfunction
• Potential adverse reaction to sedation

Benefits

• Improved heart function and efficiency
• Reduction in heart failure symptoms
• Enhanced quality of life
• Decreased hospital admissions due to heart failure

Recovery

• Initial monitoring in the hospital for 24-48 hours
• Instructions for wound care and activity limitations
• Follow-up appointments to ensure proper functioning of the device
• Gradual return to normal activities over a few weeks

Alternatives

• Medication management for heart failure
• Conventional pacemaker or defibrillator without left ventricular lead
• Heart transplant in severe cases

Patient Experience

During the procedure, the patient may feel slight pressure or discomfort at the incision site. Post-procedure, there might be mild pain or soreness, managed with pain relief medications. Patients generally experience improved symptoms within a few weeks as the heart’s function improves.