93610 Intra-atrial pacing

Name of the Procedure:

Intra-atrial Pacing

Summary

Intra-atrial pacing is a medical procedure that involves placing a pacemaker lead into the atrium of the heart to regulate its rhythm. This process is used to correct abnormal heart rhythms (arrhythmias) that originate in the atrial chambers.

Purpose

The procedure addresses arrhythmias, such as atrial fibrillation or flutter, which can cause symptoms like palpitations, dizziness, fatigue, or shortness of breath. The goal is to stabilize the heart's rhythm, improving both heart function and the patient's quality of life.

Indications

• Patients with atrial arrhythmias unresponsive to medication
• Symptomatic bradycardia (slow heart rate)
• Episodes of atrial fibrillation with rapid ventricular response
• Previous failed or inadequate response to other treatments like medications or ablation therapy

Preparation

• Fasting for at least six hours before the procedure
• Adjustments to current medications, particularly anticoagulants
• Pre-procedure diagnostic tests, such as an ECG, blood tests, and echocardiogram

Procedure Description

1. Patient receives light sedation or general anesthesia.
2. A small incision is made typically in the chest.
3. A catheter with the pacemaker lead is inserted through a vein and guided to the atrium using fluoroscopy (x-ray guidance).
4. The lead is secured in the atrium, and its connection to the pacemaker generator is tested for proper function.
5. The pacemaker generator is placed under the skin, and the incision is closed.

Duration

The procedure typically lasts between 1 to 2 hours.

Setting

Intra-atrial pacing is performed in a hospital setting, specifically in a cardiac catheterization lab or an electrophysiology lab.

Personnel

• Cardiologist or electrophysiologist
• Cardiac nurses
• Anesthesiologist or sedation nurse
• Radiologic technologist

Risks and Complications

• Infection at the implantation site
• Bleeding or bruising
• Dislodgement of the pacemaker lead
• Damage to blood vessels or heart tissue
• Rarely, cardiac tamponade (fluid around the heart)

Benefits

• Improved heart rhythm control
• Reduction of symptoms like palpitations and dizziness
• Enhanced overall heart function and improved quality of life
• Benefits can be realized immediately, though full stabilization might take a few weeks

Recovery

• Hospital stay typically lasts 1-2 days for monitoring
• Instructions on wound care and signs of infection
• Activity restrictions for several weeks to allow lead securement
• Follow-up appointments for device checks and adjustments

Alternatives

• Medication management for arrhythmias
• Catheter ablation to isolate abnormal pathways
• Direct-current cardioversion (electrical shock to reset heart rhythm)
• Each alternative has its own pros and cons, with pacing offering a more permanent and reliable solution in certain conditions

Patient Experience

• During the procedure, patients under general anesthesia will not feel anything, while those under light sedation may feel minimal discomfort.
• Some soreness and bruising at the incision site post-procedure.
• Managed pain relief with prescribed medications.
• Gradual return to normal activities as per physician guidance.