Removal of single or dual chamber implantable defibrillator electrode(s); by transvenous extraction
CPT4 code
Name of the Procedure:
Removal of Single or Dual Chamber Implantable Defibrillator Electrode(s); by Transvenous Extraction
Summary
This procedure involves the removal of one or two electrodes (wires) from an implantable defibrillator using a technique that accesses the veins. An implantable defibrillator is a device that helps to regulate heart rhythms.
Purpose
This procedure is performed to remove malfunctioning or unnecessary electrodes from an implantable defibrillator system. The goals are to ensure proper device function, avoid infections, and manage complications caused by the electrodes.
Indications
- Infection at the electrode site
- Electrode malfunction or damage
- Lead-related complications such as perforation or dislodgement
- Decision to upgrade or downgrade the defibrillator system
- Persistent pain at the implant site
Preparation
- Patients may need to fast for a certain period before the procedure.
- Adjustment or temporary discontinuation of specific medications may be required.
- Pre-procedure diagnostic tests such as blood tests, EKG, and imaging studies will be conducted to assess patient condition.
Procedure Description
- The patient is positioned on an operating table and provided with sedation or general anesthesia.
- A small incision is made at the site where the leads are connected to the defibrillator.
- Specialized tools are used to carefully extract the electrodes from the veins and the tissue.
- The site is then checked for bleeding or other complications.
- The incision is closed with sutures and dressed.
Tools used include extraction sheaths, laser sheaths, or mechanical sheaths. Anesthesia or sedation minimizes discomfort during the procedure.
Duration
The procedure typically lasts between 2 to 4 hours.
Setting
It is usually performed in a hospital's cardiac catheterization lab or an operating room.
Personnel
- Cardiologist or Cardiac Surgeon
- Anesthesiologist
- Nurses
- Technicians specializing in electrophysiology
Risks and Complications
- Bleeding
- Infection
- Blood clots
- Damage to blood vessels or the heart
- Need for emergency surgery
- Rarely, death
Benefits
- Resolution of infection or complications related to the electrodes
- Proper functioning of the defibrillator
- Long-term improvement in heart rhythm management Improvements might be noticeable immediately or over a few days as healing occurs.
Recovery
- Patients are usually observed in the hospital for one or two days post-procedure.
- Instructions include wound care, activity restrictions, and a follow-up appointment.
- Full recovery typically takes a few weeks, during which strenuous activities should be avoided.
Alternatives
- Conservative management of any complications, such as antibiotics for infection
- Open surgical removal of the electrodes Each alternative varies in terms of invasiveness, risk, and recovery time.
Patient Experience
Patients might feel some discomfort or soreness at the incision site. Pain can generally be managed with medications. Most patients experience significant relief from symptoms caused by malfunctioning electrodes after the procedure.