0387T Transcatheter insertion or replacement of permanent leadless pacemaker, ventricular

Name of the Procedure:

Transcatheter insertion or replacement of permanent leadless pacemaker, ventricular

Summary

This procedure involves placing a small, battery-powered device called a leadless pacemaker directly into the right ventricle of the heart through a catheter. Unlike traditional pacemakers, it doesn't require leads (wires) or a surgical pocket.

Purpose

The primary purpose of this procedure is to treat bradycardia, a condition where the heart beats too slowly. By providing electrical stimulation to the heart muscle, the pacemaker ensures a regular and adequate heartbeat.

Indications

• Symptoms of bradycardia, such as fatigue, dizziness, or fainting.
• Conditions like atrioventricular block or sick sinus syndrome.
• Patients who cannot undergo traditional pacemaker implantation due to certain anatomical or medical reasons.

Preparation

• Patients may need to fast for 6-8 hours before the procedure.
• Adjustments to medications, especially blood thinners, may be necessary.
• Routine pre-procedure tests may include blood work, an electrocardiogram (ECG), and possibly imaging studies like an echocardiogram.

Procedure Description

1. The patient is usually given local anesthesia and mild sedation.
2. A catheter is inserted through a vein in the groin area and guided to the heart.
3. The leadless pacemaker is delivered through the catheter and positioned inside the right ventricle.
4. The device is securely attached to the heart muscle.
5. The catheter is then removed, and the insertion site is closed and bandaged.

Duration

The procedure typically takes about 60-90 minutes.

Setting

The procedure is performed in a hospital, specifically in a cardiac catheterization lab.

Personnel

• Cardiologist specialized in electrophysiology
• Nurses
• Anesthesiologist or sedation nurse
• Radiology technician

Risks and Complications

• Bleeding or bruising at the insertion site
• Infection
• Perforation of the heart
• Device dislodgement
• Vascular complications

Benefits

• Rapid and effective regulation of heart rhythms
• Minimal surgical wounds and faster recovery times compared to traditional pacemakers
• Improved quality of life and reduced symptoms of bradycardia

Recovery

• Patients may need to stay in the hospital overnight for monitoring.
• Instructions may include avoiding heavy lifting and strenuous activities for a few days.
• Follow-up appointments for device check and incision site evaluation are necessary.
• Complete recovery typically occurs within a week.

Alternatives

• Traditional pacemaker implantation involving leads.
• Medication therapy to manage symptoms of bradycardia.
• Lifestyle changes, though less effective for severe cases.

Patient Experience

During the procedure, patients may feel pressure or minor discomfort at the catheter insertion site. Post-procedure, minor soreness and bruising are common, but pain management is readily available. Most patients return to normal activities fairly quickly, often within a few days.