33227 Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system

Name of the Procedure:

Removal and Replacement of Permanent Pacemaker Pulse Generator (Single Lead System)

• May be referred to as "Pacemaker Generator Exchange" or "Pacemaker Battery Replacement."

Summary

This procedure involves removing an existing pacemaker pulse generator and replacing it with a new one while maintaining the single lead system that connects to the heart. It's typically necessary when the battery of the existing pacemaker is depleted.

Purpose

The procedure addresses the need for a functioning pacemaker in individuals whose current pacemaker has a depleted battery or is malfunctioning. The primary goal is to restore effective pacing of the heart, ensuring that it maintains a regular rhythm, which is critical for normal cardiac function.

Indications

• Symptoms of pacemaker battery depletion such as dizziness, fatigue, fainting spells, or slow heart rate.
• Scheduled battery replacement due to nearing end-of-life as indicated by device settings and monitoring.
• Malfunction of the existing pacemaker pulse generator.
• Patients with a single lead pacemaker system, typically implanted for conditions like bradycardia (slow heart rate).

Preparation

• Fasting may be required for 8 hours before the procedure.
• Medication adjustments, possibly including stopping blood thinners.
• Pre-operative tests such as ECG (Electrocardiogram), chest X-ray, and blood tests.

Procedure Description

1. The procedure is typically done under local anesthesia with sedative support if needed.
2. A small incision is made at the site of the existing pacemaker.
3. The old pulse generator is detached from the lead(s) and removed.
4. The new pulse generator is connected to the existing lead(s) and tested to ensure proper function.
5. The new device is placed in the same "pocket" or space under the skin.
6. The incision is then closed with sutures, and a sterile dressing is applied.

Duration

The procedure usually takes about 1 to 2 hours.

Setting

Performed in a hospital's specialized cardiac procedure room or surgical center.

Personnel

• A cardiologist or cardiac surgeon.
• Nurses specializing in cardiac procedures.
• An anesthesiologist or nurse anesthetist for sedation management.

Risks and Complications

• Infection at the incision site.
• Bleeding or bruising.
• Lead displacement or damage.
• Rarely, allergic reactions to materials or medications used.
• Complications related to anesthesia.

Benefits

• Restoration of normal heart rhythm.
• Alleviation of symptoms associated with pacemaker malfunction.
• Improved quality of life through regulation of heart rate.
• Immediate benefits often realized within a day of the procedure.

Recovery

• Most patients can return home the same day or the following day.
• Keep the incision site dry and clean.
• Avoid strenuous activity and heavy lifting for a few weeks.
• Follow-up appointments to check pacemaker function and wound healing.

Alternatives

• Continued monitoring if battery life is borderline.
• Advanced alternatives like a dual-lead or biventricular pacemaker, based on specific medical needs.
• Each alternative has its pros and cons which should be discussed with the cardiologist.

Patient Experience

• Mild discomfort or pain at the incision site post-procedure, manageable with prescribed medications.
• Minor activity restrictions to ensure healing.
• Regular monitoring of the device post-procedure to ensure it is working correctly.
• Emphasis on patient comfort and pain management throughout the process.