33272 Removal of subcutaneous implantable defibrillator electrode

Name of the Procedure:

Removal of Subcutaneous Implantable Defibrillator Electrode

Summary

This procedure involves the surgical removal of an electrode from a subcutaneous implantable cardioverter-defibrillator (S-ICD) system. The electrode is a wire that helps monitor the heart's rhythm and deliver shocks if an abnormal rhythm is detected.

Purpose

The procedure addresses issues such as infection, electrode malfunction, or migration (movement from its original position). The goal is to safely remove the electrode to resolve these issues and to possibly allow for further treatment or implantation of a new system.

Indications

• Infection at the implantation site
• Malfunctioning or damaged electrode
• Electrode migration or improper positioning
• Patient's need to upgrade or change implantable devices

Preparation

• Fasting for a certain period before the procedure as instructed by the healthcare provider
• Medication adjustments, including stopping certain blood thinners
• Pre-procedure imaging studies or assessments like an X-ray or ECG

Procedure Description

1. Preparation and Anesthesia: The patient is placed under local or general anesthesia based on the complexity of the case and patient factors.
2. Incision: A small incision is made at the site where the electrode is located.
3. Electrode Identification and Disconnection: Using imaging guidance, the electrode is carefully identified and disconnected from the defibrillator.
4. Removal: The electrode is gently extracted from the subcutaneous tissue.
5. Closure: The incision site is closed with sutures or surgical glue.
6. Post-procedure Imaging: To ensure complete removal and proper closure.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

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

Personnel

• Cardiothoracic Surgeon or Electrophysiologist
• Anesthesiologist
• Surgical Nurses
• Radiologist (if imaging guidance is needed)

Risks and Complications

• Infection
• Bleeding or hematoma
• Damage to surrounding tissues or vessels
• Pain or discomfort at the incision site
• Need for additional surgery if complications arise

Benefits

• Resolution of infection, device malfunction, or pain caused by the electrode
• Potentially improved heart function and patient comfort
• Short-term benefits typically observed within a few weeks

Recovery

• Close observation for a few hours post-procedure
• Pain management with prescribed medications
• Wound care instructions and keeping the incision site clean and dry
• Restrictions on heavy lifting and strenuous activities for a few weeks
• Follow-up appointments to monitor healing and discuss further treatment options

Alternatives

• Ongoing conservative management of symptoms if immediate removal is not critical
• Antibiotic therapy for mild infections without electrode removal
• Repositioning of the electrode instead of full removal, if feasible

Patient Experience

• During the procedure, if under local anesthesia, the patient might feel some pressure but should not feel pain.
• Post-procedure discomfort is managed with medications.
• Patients might experience some bruising and swelling at the incision site, with these symptoms usually improving within a few days.