33206 Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial

Name of the Procedure:

Insertion of New or Replacement of Permanent Pacemaker with Transvenous Electrode(s); Atrial

Summary

In this procedure, doctors place a pacemaker - a small electronic device - into your chest or abdomen to help manage abnormal heart rhythms. The pacemaker sends electrical impulses through a wire (electrode) placed in the atrial chamber of the heart, ensuring it beats regularly.

Purpose

The primary goal is to correct abnormal heart rhythms, specifically when the heart is beating too slowly (bradycardia). The pacemaker ensures a regular heartbeat, which helps improve blood flow and overall heart function.

Indications

• Symptoms such as dizziness, fatigue, fainting, or shortness of breath associated with bradycardia.
• Diagnoses of heart block or sinus node dysfunction.
• Patients with existing pacemakers that need replacement due to battery depletion or malfunction.
• Individuals at risk of sudden cardiac arrest.

Preparation

• Patients may be instructed to fast for 6-8 hours before the procedure.
• Certain medications, especially blood thinners, may need to be adjusted.
• Pre-procedure tests might include an electrocardiogram (ECG), blood tests, and imaging studies like a chest X-ray.
• A physical examination and a review of the patient's medical history will be conducted.

Procedure Description

1. The patient is given local anesthesia and, in some cases, mild sedation.
2. A small incision is made near the shoulder or upper chest.
3. Using fluoroscopy (real-time X-ray), the physician inserts a lead (electrode) through a vein leading to the right atrium of the heart.
4. The lead is positioned and tested to ensure it provides adequate electrical stimulation.
5. The lead is connected to the pacemaker device, which is then placed under the skin near the incision.
6. The incision is closed with stitches, and the device's settings are programmed and tested.
7. The patient is monitored for a short period before being discharged.

Duration

The procedure typically takes 1-2 hours.

Setting

The procedure is usually performed in a hospital’s cardiac catheterization lab or an operating room.

Personnel

• Cardiologist or electrophysiologist (specialized in heart rhythm disorders)
• Cardiac nurses
• Anesthesiologist or conscious sedation nurse
• Radiologic technologist

Risks and Complications

• Infection at the implantation site
• Bleeding or bruising
• Lead dislodgement or malfunction
• Pneumothorax (collapsed lung)
• Allergic reaction to anesthesia
• Rare complications include stroke or heart attack.

Benefits

• Restoration of normal heart rhythm
• Relief from symptoms like dizziness, fatigue, and fainting
• Improved quality of life
• Reduced risk of heart failure and sudden cardiac arrest
• Benefits can typically be felt immediately after recovery.

Recovery

• Patients are usually monitored overnight and may go home the next day.
• Instructions include keeping the incision site clean and dry, monitoring for signs of infection, and limiting certain arm movements for a few weeks.
• Most patients can return to normal activities within 4-6 weeks.
• Follow-up appointments are necessary to adjust pacemaker settings and ensure proper function.

Alternatives

• Medications to manage heart rhythm disorders
• External pacemakers (temporary solution)
• Other surgical interventions like ablation therapy
• The alternative options vary in invasiveness and effectiveness compared to a permanent pacemaker.

Patient Experience

• During the procedure, patients will likely feel minimal discomfort due to local anesthesia and mild sedation.
• Post-procedure, some soreness and bruising at the incision site is common.
• Pain management typically involves over-the-counter pain relievers.
• Patients will be monitored closely post-procedure to ensure proper healing and device function.
• Long-term, patients often report significant improvement in symptoms and overall energy levels.