33207 Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); ventricular

Name of the Procedure:

Insertion of a new or replacement of a permanent pacemaker with transvenous electrode(s); ventricular (also known as: Permanent Ventricular Pacemaker Insertion or Replacement)

Summary

This procedure involves placing a new pacemaker or replacing an existing one in the chest to manage abnormal heart rhythms. A transvenous electrode (lead) is threaded through a vein into the heart's ventricle to help regulate your heartbeat.

Purpose

The main purpose of this procedure is to treat conditions where the heart beats too slowly (bradycardia) or irregularly. It helps maintain a regular heart rate and rhythm, improving overall heart function and relieving symptoms such as fatigue, dizziness, and fainting.

Indications

• Symptomatic bradycardia (slow heart rate)
• Heart block (partial or complete interruption of the electrical signals in the heart)
• Heart failure management
• Replacement of a malfunctioning or depleted pacemaker

Preparation

• Fasting for at least 6-8 hours before the procedure.
• Adjusting medications as advised by your doctor.
• Pre-procedure diagnostic tests: ECG, blood tests, chest x-ray, and sometimes an echocardiogram.

Procedure Description

1. The patient is taken to the procedure room and placed on a table.
2. Regional or general anesthesia is administered.
3. A small incision is made near the collarbone.
4. A lead (electrode) is inserted through a vein and guided to the heart’s ventricle using imaging technology.
5. The lead is connected to the pacemaker device, which is placed in a small pocket created under the skin.
6. The function of the pacemaker is checked to ensure it is working properly.
7. The incision is closed with stitches.

Tools used include fluoroscope for imaging, lead/electrode, and the pacemaker device. Sedation may be light or general anesthesia depending on the case and patient's condition.

Duration

The procedure typically takes 1-2 hours.

Setting

The procedure is performed in a hospital, specifically in a catheterization lab or an operating room equipped with imaging equipment.

Personnel

• Cardiologist or Cardiac Electrophysiologist (primary surgeon)
• Nurses
• Anesthesiologist
• Radiology technician

Risks and Complications

• Infection at the incision site
• Bleeding or bruising
• Lead displacement or malfunction
• Pneumothorax (collapsed lung)
• Adverse reaction to anesthesia
• Rarely, heart perforation

Benefits

• Relief from symptoms of bradycardia and heart block.
• Improved quality of life and daily functioning.
• Prevention of fainting spells and fatigue.
• Increased lifespan.

Benefits may be realized immediately or shortly after recovery.

Recovery

• Observation in the hospital for 1-2 days.
• Avoiding heavy lifting and strenuous activities for several weeks.
• Follow-up appointments to check pacemaker function.
• Incision care as instructed by the healthcare provider.

Expected recovery time is about 4-6 weeks for full healing.

Alternatives

• Medication management (though not always sufficient).
• Implantable cardioverter-defibrillator (ICD) for certain types of arrhythmias.
• Lifestyle changes and other minor interventions.

Each alternative has its pros and cons, with pacemaker insertion often being the most effective for severe bradycardia.

Patient Experience

During the procedure, you may be sedated and will likely feel minimal discomfort. Post-procedure, some soreness or bruising at the incision site is normal. Pain management options will be provided, and most discomfort subsides within a few days. Regular check-ups will ensure the pacemaker is functioning properly, and you'll steadily return to normal activities as you heal.