33217 Insertion of 2 transvenous electrodes, permanent pacemaker or implantable defibrillator

Name of the Procedure:

Insertion of 2 Transvenous Electrodes, Permanent Pacemaker or Implantable Defibrillator
Common name(s): Pacemaker Insertion, Implantable Defibrillator Insertion
Technical/Medical term: Transvenous Lead Placement for Cardiac Device

Summary

A procedure to insert two thin, flexible wires (electrodes) through veins, which are then connected to a permanent pacemaker or implantable defibrillator. These devices help regulate and control the heart's rhythm.

Purpose

This procedure addresses heart rhythm disorders, such as bradycardia (slow heart rate) and arrhythmias (irregular heartbeats). The goal is to ensure the heart maintains a regular, adequate rhythm to pump blood effectively throughout the body.

Indications

• Symptoms such as dizziness, fatigue, fainting, or shortness of breath.
• Diagnosed conditions, including bradycardia, tachycardia, heart block, or ventricular fibrillation.
• Patients with a history of heart attacks or those at risk for sudden cardiac arrest.

Preparation

• Patients may need to fast for several hours before the procedure.
• Medication adjustments may be required, particularly for blood thinners or heart-related drugs.
• Pre-procedure diagnostic tests may include an ECG, blood tests, or imaging studies like a chest X-ray.

Procedure Description

1. The patient is given local anesthesia and possibly light sedation.
2. A small incision is made near the collarbone.
3. Two flexible wires (electrodes) are inserted through a vein, usually in the upper chest area, and guided to the heart.
4. The electrodes are tested to ensure they are in the correct position and functioning.
5. The other ends of the electrodes are connected to the pacemaker or defibrillator, which is then placed under the skin.
6. The incision is closed with sutures.

Tools and Equipment:

• Fluoroscope for real-time X-ray imaging.
• Electrodes (leads).
• Pacemaker or defibrillator device.

Duration

The procedure typically takes 1 to 2 hours.

Setting

Performed in a hospital, specifically in a catheterization lab or a specialized electrophysiology lab.

Personnel

• Cardiologist or cardiac electrophysiologist
• Nurses
• Radiologic technologist
• Anesthesiologist or sedation nurse (depending on sedation needs)

Risks and Complications

• Common: Infection, bleeding, or bruising at the incision site.
• Rare: Pneumothorax (collapsed lung), lead dislodgement, or device malfunction.
• Management: Most complications are managed with medications or minor additional procedures.

Benefits

• Regulation of heart rhythm, reducing symptoms like dizziness and fatigue.
• Prevention of life-threatening arrhythmias or cardiac arrest.
• Most patients feel an improvement in symptoms within days to a couple of weeks after the procedure.

Recovery

• Initial recovery involves staying overnight in the hospital for monitoring.
• Restrictions on lifting the arm near the incision site for several weeks.
• Follow-up appointments to monitor device function and adjust settings if needed.
• Full recovery typically takes several weeks.

Alternatives

• Medication management of arrhythmias.
• External defibrillator use.
• Lifestyle and dietary changes.

Pros and Cons:

• Medications: Less invasive but might not be as effective for all heart rhythm issues.
• External defibrillator: Non-invasive but less convenient and effective than an implanted device.

Patient Experience

• During the procedure: Patients may feel some pressure or mild discomfort, but pain is minimal due to local anesthesia and sedation.
• After the procedure: Mild discomfort at the incision site, managed with over-the-counter pain relievers.
• Quick return to normal activities, with specific restrictions on strenuous activity until fully healed.