33203 Insertion of epicardial electrode(s); endoscopic approach (eg, thoracoscopy, pericardioscopy)

Name of the Procedure:

Insertion of Epicardial Electrode(s); Endoscopic Approach (e.g., Thoracoscopy, Pericardioscopy)

Summary

In this minimally invasive procedure, small electrodes are implanted on the surface of the heart using an endoscopic approach. This allows physicians to monitor and regulate the heartbeat, often necessary for patients with irregular heart rhythms.

Purpose

The primary goal of the procedure is to provide electrical stimulation to the heart. It is commonly used to manage and treat arrhythmias (irregular heartbeats).

Indications

• Symptoms such as palpitations, dizziness, or fainting due to irregular heart rhythms.
• Conditions like atrial fibrillation, ventricular tachycardia, or heart block.
• When non-invasive treatments and medications have proven ineffective.

Preparation

• Patients are typically required to fast for at least 6-8 hours before the procedure.
• Medication adjustments may be necessary, especially blood thinners.
• Pre-procedure diagnostic tests include ECG, blood tests, and possibly imaging studies like an echocardiogram.

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incision: Small incisions are made in the chest to introduce the endoscope.
3. Endoscopic Access: Using thoracoscopy or pericardioscopy, the surgeon locates the heart.
4. Electrode Placement: Electrodes are affixed to the heart's surface (epicardium).
5. Connection and Testing: Electrodes are connected to a generator, and their placement is tested.
6. Closure: Incisions are closed and dressed.

Duration

The procedure typically takes 2 to 3 hours.

Setting

Performed in a hospital's operating room, often within a specialized cardiac surgery unit.

Personnel

• Lead cardiac surgeon
• Anesthesiologist
• Surgical nurses
• Technicians specialized in cardiac monitoring

Risks and Complications

• Common: Infection at incision sites, bleeding, bruising.
• Rare: Heart damage, pericardial effusion, electrode displacement, anesthesia-related complications.

Benefits

• Improved heart rhythm management.
• Reduced symptoms such as dizziness or fainting.
• Enhanced quality of life with a more stable heartbeat.

Recovery

• Initial hospital stay of 1-2 days for monitoring.
• Avoid strenuous activities for a few weeks.
• Follow-up appointments for device checks and adjustments.
• Pain management may include medications for the first few days.

Alternatives

• Medication therapy: Less invasive but may be less effective for some patients.
• Transvenous pacing: Another type of implantable cardiac device, but may not be suitable for all.
• Lifestyle changes: Can help but are often insufficient alone.

Patient Experience

• During: The patient will be under general anesthesia and unaware of the procedure.
• After: Expect some soreness at incision sites and chest; manageable with prescribed pain relief.
• Emotional and psychological support can enhance recovery experience.