33208 Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular

Name of the Procedure:

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

Summary

A pacemaker is a small, battery-operated device that helps your heart beat in a regular rhythm. This procedure involves placing a new or replacing an existing permanent pacemaker with leads (electrodes) that go into both the atrium and ventricle of the heart through the veins.

Purpose

The primary goal of this procedure is to help manage heart rhythm disorders, such as bradycardia (slow heart rate) or heart block. By ensuring a consistent heart rate and rhythm, it helps to alleviate symptoms like fatigue, dizziness, or fainting, and reduce the risk of heart complications.

Indications

This procedure is indicated for patients with:

• Symptomatic bradycardia or heart block
• Sick sinus syndrome
• Atrial fibrillation with slow ventricular response
• Previous pacemaker malfunction

Preparation

• Patients are instructed to fast for at least 6-8 hours before the procedure.
• Medication adjustments may be required, particularly with blood thinners.
• Pre-procedural diagnostic tests such as electrocardiogram (EKG), echocardiogram, or blood tests are performed.

Procedure Description

1. The patient is positioned on the surgical table and intravenous (IV) lines are placed.
2. Local anesthesia and sedation are administered.
3. A small incision is made near the collarbone.
4. Leads (electrodes) are inserted through a vein and guided to the heart's atrium and ventricle under fluoroscopy (real-time x-ray imaging).
5. The pacemaker device is implanted under the skin near the incision.
6. The leads are connected to the pacemaker, which is then programmed and tested to ensure proper function.
7. The incision is closed with sutures.

Duration

The procedure typically takes about 2 to 3 hours.

Setting

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

Personnel

The healthcare team includes:

• A cardiologist or cardiac surgeon
• An anesthesiologist or sedation nurse
• Scrub nurses or technicians
• Radiologic technologists

Risks and Complications

• Infection at the implantation site
• Bleeding or bruising
• Lead displacement
• Pneumothorax (collapsed lung)
• Device malfunction or failure
• Blood vessel damage

Benefits

• Improved heart rhythm and rate
• Alleviation of symptoms such as dizziness and fatigue
• Enhanced quality of life and reduced risk of heart complications
• Immediate benefits may be noticed shortly after the procedure.

Recovery

• Patients typically stay in the hospital for 1 to 2 days for monitoring.
• Post-procedure care includes keeping the incision site clean and dry.
• Limiting arm movements on the side of the incision for a few weeks.
• Regular follow-up appointments for device check-ups and monitoring.

Alternatives

• Medication to manage heart rhythms, though they may be less effective for some conditions.
• Other types of cardiac rhythm devices like implantable cardioverter-defibrillators (ICDs), depending on the specific heart condition.

Patient Experience

• During the procedure, patients are usually comfortable due to local anesthesia and sedation.
• Post-procedure discomfort around the incision site is common but manageable with pain relief medications.
• Patients might feel the pacemaker but typically get used to it within a few weeks.