Insertion of epicardial electrode(s); open incision (eg, thoracotomy, median sternotomy, subxiphoid approach)
CPT4 code
Name of the Procedure:
Insertion of Epicardial Electrode(s); Open Incision (e.g., thoracotomy, median sternotomy, subxiphoid approach)
Summary
This procedure involves surgically placing wires (electrodes) on the epicardial surface of the heart (the outer layer) using an open incision. These electrodes are used to temporarily or permanently monitor heart activity or deliver electrical impulses to the heart.
Purpose
The primary purpose of this procedure is to manage conditions such as arrhythmias (irregular heartbeats) by providing electrical impulses to the heart to maintain a normal rhythm or to gather precise data on heart activity. The expected outcomes include improved heart function and better management of cardiac conditions.
Indications
This procedure is indicated for patients with:
- Severe arrhythmias not manageable by medication.
- A need for temporary pacing guidance post-heart surgery.
- Congenital or structural heart anomalies requiring precise electrical assessment.
It is often chosen for patients who require direct cardiac monitoring or pacing where transvenous (through veins) options are not viable.
Preparation
Patients are typically required to:
- Fast for 6-8 hours before the procedure.
- Adjust or discontinue certain medications, especially blood thinners.
- Undergo pre-operative assessments, including blood tests, ECG, echocardiogram, and imaging studies.
Procedure Description
- Anesthesia: The patient is given general anesthesia to induce sleep and prevent pain.
- Incision: A surgical incision is made either via thoracotomy (side chest), median sternotomy (center chest), or subxiphoid approach (below the chest).
- Exposing the Heart: The surgeon carefully exposes the heart.
- Placing Electrodes: Epicardial electrodes are stitched or applied directly to the heart's surface.
- Connecting to Device: These electrodes are connected to an external pacing device or monitor.
- Closing Incision: The surgeon sutures the chest incision and places a dressing over the site.
Standard surgical tools, including scalpels, sutures, and specialized heart electrodes, are used.
Duration
The procedure typically takes between 1.5 to 3 hours to complete.
Setting
This procedure is performed in a hospital, specifically in a sterile operating room equipped for cardiac surgery.
Personnel
The healthcare team includes:
- Cardiothoracic surgeon
- Anesthesiologist
- Surgical nurses
- Cardiologist (in some cases)
Risks and Complications
Common risks:
- Infection at the incision site
- Bleeding
- Pain around the incision
Rare risks:
- Heart damage
- Blood clots
- Stroke
- Adverse reactions to anesthesia
Benefits
The benefits include improved heart rhythm control, enhanced monitoring of heart function, and potentially lifesaving intervention. Benefits are often realized immediately post-procedure, especially in emergency pacing situations.
Recovery
Post-procedure care involves:
- Monitoring in the Intensive Care Unit (ICU) for 24-48 hours.
- Pain management with prescribed medications.
- Gradual resumption of physical activities.
- Follow-up appointments to ensure proper device function and wound healing.
The expected recovery time varies but generally spans from 2 to 6 weeks.
Alternatives
Alternatives include:
- Transvenous pacing (non-surgical)
- Medication management for arrhythmias
- Catheter ablation for certain types of arrhythmias
Pros of alternatives often include less invasiveness and shorter recovery times, while cons may include lower efficacy in certain conditions or incompatibility with the patient's medical status.
Patient Experience
Patients will generally experience some discomfort and pain at the incision site post-surgery but will receive medications to manage these symptoms. Continuous heart monitoring will be in place to ensure the proper function of the epicardial electrodes. The care team will provide extensive support and guidance to ensure a smooth recovery process.