33216 Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator

Name of the Procedure:

Insertion of a Single Transvenous Electrode for a Permanent Pacemaker or Implantable Defibrillator (single lead pacemaker or single lead ICD insertion).

Summary

This procedure involves placing a thin, flexible wire (electrode) through a vein into the heart to help regulate heartbeats. The wire is connected to a small device, either a pacemaker or an implantable cardioverter-defibrillator (ICD), which is implanted under the skin.

Purpose

The procedure aims to treat heart rhythm problems, such as bradycardia (slow heartbeat) or heart failure, and to prevent sudden cardiac arrest. The pacemaker/ICD monitors and ensures the heart beats at a normal rhythm, delivering electrical impulses when needed.

Indications

• Symptoms of bradycardia, such as fatigue, dizziness, or fainting.
• Diagnosed heart arrhythmias like atrial fibrillation.
• Conditions that increase the risk of sudden cardiac arrest.
• Heart failure with a reduced ejection fraction.

Preparation

• Patients may need to fast for several hours before the procedure.
• Certain medications might need to be adjusted or stopped.
• Pre-procedure tests may include an electrocardiogram (ECG), echocardiogram, and blood tests.

Procedure Description

1. The patient is positioned on an operating table, and an intravenous (IV) line is placed.
2. Local anesthesia and sedation are administered to ensure comfort.
3. A small incision is made near the collarbone.
4. A sheath is inserted into a vein, usually the subclavian vein.
5. The electrode wire is threaded through the sheath into the heart.
6. The electrode's position is confirmed using fluoroscopy (real-time X-ray).
7. Once in place, the electrode is attached to the pacemaker/ICD device.
8. The device is implanted under the skin, and the incision is closed.

Duration

Typically, the procedure takes about 1 to 2 hours.

Setting

This procedure is usually performed in a hospital's electrophysiology (EP) lab or an operating room.

Personnel

• Cardiologist or electrophysiologist.
• Surgical nurse.
• Anesthesiologist or sedation nurse.
• Radiology technician.

Risks and Complications

• Infection at the incision site.
• Bleeding or bruising.
• Displacement of the electrode.
• Damage to blood vessels or the heart.
• Allergic reaction to anesthesia.
• Rarely, heart perforation or pneumothorax (collapsed lung).

Benefits

• Regulated heart rhythm, preventing symptoms like dizziness and fainting.
• Reduced risk of sudden cardiac arrest.
• Improved quality of life and heart function.

Recovery

• Post-procedure monitoring in the hospital for 24-48 hours.
• Instructions on how to care for the incision site.
• Restrictions on heavy lifting and strenuous activities for a few weeks.
• Follow-up appointments to check the device and adjust settings if needed.

Alternatives

• Medication to manage heart rhythm issues.
• Different types of pacing systems (e.g., dual-lead pacemakers).
• Catheter ablation for certain types of arrhythmias.
• Managed observation with lifestyle changes.

Patient Experience

• Mild discomfort at the incision site and during recovery.
• Pain management with prescribed medications.
• Most patients can return to normal activities within a few weeks, with some restrictions.
• Regular follow-up to ensure the device is working properly and to adjust settings as necessary.