33231 Insertion of implantable defibrillator pulse generator only; with existing multiple leads

Name of the Procedure:

Insertion of Implantable Defibrillator Pulse Generator Only; with Existing Multiple Leads (also known as ICD Pulse Generator Replacement or ICD Battery Change)

Summary

An implantable defibrillator pulse generator replacement involves removing and replacing the pulse generator (the battery and computer unit) of an existing implantable cardioverter-defibrillator (ICD) while retaining the existing leads (wires). This procedure is often necessary when the battery of the device runs low.

Purpose

This procedure addresses the need to replace the battery of an ICD, a device that helps to correct life-threatening arrhythmias (irregular heartbeats). The goal is to ensure the ICD continues to function properly, providing life-saving shocks or pacing when abnormal heart rhythms are detected.

Indications

• Low battery indication on existing ICD device
• Malfunction or recall of the pulse generator unit
• ICD battery reaching end-of-life, usually after 5-10 years
• Patients with existing ICDs needing continued arrhythmia management

Preparation

• Fasting for 6-8 hours before the procedure may be required.
• Adjustments to medications, particularly blood thinners, as advised by the healthcare provider.
• Pre-procedure assessments often include an electrocardiogram (ECG), blood tests, and imaging studies to check the position and functioning of existing leads.

Procedure Description

1. The patient is positioned on the procedural table and the site (usually under the collarbone) is cleaned and sterilized.
2. Local anesthesia and sedation are administered to ensure patient comfort.
3. An incision is made near the existing ICD site.
4. The old pulse generator is disconnected from the existing leads and removed.
5. The new pulse generator is connected to the leads.
6. Testing is conducted to ensure the new device is functioning correctly.
7. The incision is closed with sutures or surgical glue and a sterile dressing is applied.

Tools used include sterile surgical instruments, new ICD pulse generator, and testing equipment to validate the device's function.

Duration

The procedure typically takes about 1-2 hours.

Setting

The procedure is generally performed in a hospital's electrophysiology lab or a specialized cardiology surgical center.

Personnel

• Cardiologist or electrophysiologist (specialist in heart rhythm disorders)
• Nurses
• Anesthesiologist or nurse anesthetist
• Surgical technician

Risks and Complications

• Infection at the incision site
• Bleeding or bruising
• Lead dislodgement or malfunction
• Allergic reaction to anesthesia
• Rarely, damage to the heart or surrounding tissues

Benefits

• Prolongs the life and functionality of an ICD
• Continues protection against life-threatening arrhythmias
• Immediate resumption of device functionality

Recovery

• Patients are usually monitored for several hours post-procedure.
• Most patients can go home the same day or the following day.
• Instructions include keeping the incision site clean and dry, avoiding strenuous activities for a few days, and a follow-up appointment to check the device and incision.

Alternatives

• Continuous medical management of arrhythmias without an ICD, though this may not be as effective for serious cases.
• Use of external defibrillators.
• Catheter ablation for certain types of arrhythmias.

Patient Experience

During the procedure, the patient may feel minimal discomfort due to sedation and local anesthesia. Post-procedure, some soreness and bruising at the incision site are normal. Pain management measures include over-the-counter pain relievers and following care instructions provided by the healthcare team to avoid complications.