Repositioning of previously implanted cardiac venous system (left ventricular) electrode (including removal, insertion and/or replacement of existing generator)
CPT4 code
Name of the Procedure:
Repositioning of Previously Implanted Cardiac Venous System (Left Ventricular) Electrode
Common Name(s): LV Lead Repositioning, Left Ventricular Electrode Adjustment
Summary
This procedure involves adjusting the position of a previously implanted electrode that stimulates the left ventricle of the heart. It may include removing, inserting, or replacing the existing pacemaker or defibrillator generator.
Purpose
The procedure addresses pacing or defibrillation issues in patients with devices implanted to manage heart rhythm disorders. The goal is to optimize the electrode placement for more effective cardiac function and symptom relief.
Indications
- Inadequate pacing or defibrillation from the previously implanted electrode
- Lead dislodgement or malfunction
- Suboptimal heart function despite device implantation
- Persistent symptoms such as shortness of breath or fatigue
Preparation
- Fasting for 6-8 hours before the procedure
- Adjustments to medications as directed by the healthcare provider
- Diagnostic tests such as an electrocardiogram (ECG) or echocardiogram
Procedure Description
- The patient is placed under local anesthesia with sedation or general anesthesia.
- The previously implanted pulse generator is accessed through a small incision.
- The existing lead is carefully evaluated and, if necessary, repositioned to the appropriate location within the cardiac venous system.
- If needed, the existing generator is removed and replaced.
- The incision is closed, and the device is tested to ensure proper function.
Tools/Equipment: Surgical instruments, fluoroscopy for imaging, pacemaker or defibrillator generator.
Duration
The procedure typically takes 1 to 2 hours.
Setting
The procedure is usually performed in a hospital or specialized surgical center.
Personnel
- Cardiac Electrophysiologist or Cardiothoracic Surgeon
- Nursing staff
- Anesthesiologist or nurse anesthetist
- Radiology technician
Risks and Complications
- Infection at the incision site
- Bleeding or hematoma
- Dislodgement of the repositioned lead
- Damage to blood vessels or heart tissue
- Reaction to anesthesia
- Rarely, stroke or heart attack
Benefits
- Improved heart function
- Reduced symptoms such as fatigue or shortness of breath
- Enhanced quality of life
- Greater longevity of the implanted device
Recovery
- Monitoring in the hospital for a few hours or overnight
- Pain management with prescribed medications
- Limited physical activity for a few weeks
- Follow-up appointments for device checks and wound care
Alternatives
- Medication adjustments to manage symptoms
- Conservative follow-up without repositioning, if symptoms are mild
- Device upgrade or full replacement with newer technology
Patient Experience
During the procedure, the patient will either be sedated or fully anesthetized. Post-procedure, there may be mild discomfort at the incision site, manageable with pain medications. Patients can expect to resume normal activities gradually over a few weeks, with specific guidance from their healthcare provider. Regular follow-up appointments are crucial to ensure the device functions optimally.