33274 Transcatheter insertion or replacement of permanent leadless pacemaker, right ventricular, including imaging guidance (eg, fluoroscopy, venous ultrasound, ventriculography, femoral venography) and device evaluation (eg, interrogation or programming), when

Name of the Procedure:

Transcatheter Insertion or Replacement of Permanent Leadless Pacemaker, Right Ventricular

Summary

This is a minimally invasive procedure to place or replace a leadless pacemaker into the right ventricle of the heart using catheters. Imaging techniques such as fluoroscopy and ultrasounds guide the placement, while the device's functionality is tested after insertion.

Purpose

This procedure addresses abnormal heart rhythms (arrhythmias). The goal is to regulate the heart's rhythm effectively without the need for traditional pacemaker leads.

Indications

• Symptomatic bradycardia (slow heart rate)
• Heart block (a condition where the heart's electrical signal is delayed or blocked)
• Patients for whom traditional pacemakers are unsuitable due to anatomical challenges or infection risks.

Preparation

• Fasting for 6-8 hours before the procedure.
• Stopping certain medications as directed by your doctor.
• Pre-procedure imaging tests and blood work.

Procedure Description

1. Local anesthesia is administered to numb the groin area.
2. A catheter is inserted through the femoral vein in the groin and guided to the heart using imaging techniques like fluoroscopy.
3. The leadless pacemaker is delivered through the catheter and positioned in the right ventricle.
4. The device is anchored and its functionality is tested (interrogation or programming).
5. The catheter is removed, and pressure is applied to the insertion site to stop any bleeding.

Duration

Typically 1-2 hours.

Setting

Hospital catheterization lab or specialized cardiac center.

Personnel

• Cardiologist or electrophysiologist
• Nurse or medical assistant
• Anesthesiologist or sedation nurse

Risks and Complications

• Infection at the insertion site
• Blood vessel damage
• Arrhythmias
• Pacemaker displacement
• Rarely, blood clots or heart perforation.

Benefits

• Effective heart rhythm management without leads
• Reduced risk of infection compared to traditional pacemakers
• Shorter recovery time
• Less invasive with fewer surgical risks

Recovery

• Monitoring in the hospital for a few hours post-procedure.
• Avoiding strenuous activity for a few days.
• Follow-up appointment for pacemaker function check.
• Watching for signs of complications such as swelling, redness, or pain at the insertion site.

Alternatives

• Traditional pacemaker with leads
• Medication management for arrhythmia
• Other types of cardiac rhythm management devices

Pros:

• Traditional pacemakers can be more suitable for certain heart conditions.
• Different devices may offer more tailored features for specific arrhythmias.

Cons:

• Traditional pacemakers have higher infection risks due to leads.
• Medications may be less effective in managing severe arrhythmias.

Patient Experience

• Mild discomfort during catheter insertion.
• Some pressure or a pulling sensation as the pacemaker is positioned.
• Potential groin soreness post-procedure.
• Pain management typically involves over-the-counter pain relievers and resting the groin area.