33233 Removal of permanent pacemaker pulse generator only

Name of the Procedure:

Removal of Permanent Pacemaker Pulse Generator Only \ Alternate names: Pacemaker generator replacement, pacemaker battery replacement.

Summary

The removal of a permanent pacemaker pulse generator involves surgically taking out the small device that helps regulate the heart's rhythm. This procedure mainly addresses the tissue around the generator without disturbing the leads (wires) attached to the heart.

Purpose

This procedure is typically performed to replace a depleted or malfunctioning pacemaker pulse generator. The goal is to ensure the patient continues to have an effective device to manage their heart rhythm disorders.

Indications

• Battery depletion in the pacemaker.
• Malfunction of the pacemaker.
• Infection at the pacemaker site.
• Upgrading to a newer model with additional features.
• Mechanical issues like device recall.

Preparation

• Fasting for several hours before the procedure.
• Adjustment or temporary discontinuation of certain medications (e.g., blood thinners).
• Diagnostic tests such as ECG, blood tests, and chest X-rays.
• Consultation with a cardiologist and anesthesiologist.

Procedure Description

1. Anesthesia Administration: Local anesthesia or mild sedation.
2. Incision: A small incision is made over the site of the pacemaker in the chest.
3. Generator Removal: The current pacemaker generator is detached from the existing leads.
4. Inspection and Potential Lead Testing: The leads are tested to ensure they are still functioning properly.
5. Generator Replacement (if necessary): A new generator is attached to the leads and placed back into the chest pocket.
6. Closure: The incision is closed with stitches or surgical glue and covered with a sterile dressing.

Duration

The procedure typically lasts about 1 to 2 hours.

Setting

This procedure is commonly performed in a hospital's cardiac catheterization lab or an outpatient surgical center.

Personnel

• Cardiologist or cardiothoracic surgeon.
• Anesthesiologist or nurse anesthetist.
• Registered nurses.
• Surgical technologist.

Risks and Complications

• Infection at the incision site.
• Bleeding or hematoma formation.
• Lead damage or dislodgement.
• Pain or discomfort at the incision site.
• Rare risks: Pneumothorax, heart or blood vessel injury.

Benefits

• Continued effective pacing of the heart.
• Prevention of symptoms like dizziness, fainting, or heart failure.
• Improved quality of life.
• Reduced risk of sudden cardiac events.

Recovery

• Monitoring in a recovery area for several hours post-procedure.
• Instructions to keep the incision site dry and clean.
• Limitation on arm movements on the side of the pacemaker for a few weeks.
• Follow-up appointments to check pacemaker function and wound healing.

Alternatives

• Medical management with medications (typically less effective for rhythm disorders).
• External (temporary) pacing devices (short-term solution).
• Electrophysiological studies and ablation (if arrhythmia can be treated in such a manner). Pros and cons should be discussed in detail with the cardiologist.

Patient Experience

During the procedure, the patient will be under local anesthesia and may feel some pressure but minimal pain. Post-procedure pain is usually mild to moderate, managed with over-the-counter pain relievers. Some bruising and tenderness around the incision site are common. Overall, most patients can resume normal activities within a few days to a week.