33249 Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber

Name of the Procedure:

Insertion or Replacement of Permanent Implantable Defibrillator System (Transvenous Lead(s), Single or Dual Chamber)

Summary

This procedure involves implanting or replacing a permanent defibrillator device that monitors and corrects abnormal heart rhythms. The device typically consists of wires (leads) placed inside the heart and a small generator implanted under the skin.

Purpose

The procedure addresses serious heart rhythm disorders (arrhythmias), such as ventricular tachycardia or fibrillation. The goal is to prevent sudden cardiac arrest by providing life-saving shocks to restore normal heart rhythm.

Indications

• History of life-threatening arrhythmias.
• Previous sudden cardiac arrest.
• Severe heart failure with high risk of arrhythmia.
• Inherited heart conditions prone to arrhythmias.

Preparation

• Fasting for at least 6 hours before the procedure.
• Adjustment or discontinuation of certain medications as advised by the physician.
• Pre-procedure diagnostic tests like ECG, blood tests, and imaging (echocardiogram or X-ray).

Procedure Description

1. Anesthesia: Local anesthesia with sedation or general anesthesia.
2. Incision: A small incision is made near the collarbone.
3. Lead Placement: Leads (wires) are guided through a vein into the heart.
4. Generator Placement: The generator is implanted under the skin, often below the collarbone.
5. Connection and Testing: Leads are connected to the generator and tested to ensure proper function.
6. Closure: Incision is closed with sutures and a sterile dressing is applied.

Duration

Typically takes 1 to 3 hours.

Setting

The procedure is performed in a hospital setting, usually in a cardiac catheterization lab or operating room.

Personnel

The procedure involves a team of healthcare professionals, including:

• Cardiologist or Cardiovascular Surgeon.
• Anesthesiologist or Nurse Anesthetist.
• Cardiac Nurse.
• Radiologic Technicians.

Risks and Complications

• Common: Infection, bleeding, and bruising at the implantation site.
• Rare: Lead displacement, device malfunction, blood clots, or pneumothorax.

Benefits

• Immediate and life-saving response to life-threatening arrhythmias.
• Long-term prevention of sudden cardiac arrest.
• Improved quality of life and increased survival rates.

Recovery

• Initial hospital stay of 1-2 days for observation.
• Instructions: Avoid heavy lifting and strenuous activity for a few weeks.
• Follow-up: Regular check-ups for device function and battery status.
• Full recovery: Typically within 4-6 weeks.

Alternatives

• Medications to manage arrhythmias.
• External wearable defibrillator.
• Ablation therapy to correct heart rhythm issues.
• Each alternative has different efficacy, risks, and lifestyle implications.

Patient Experience

• Sensation of a small shock or jolt when the defibrillator activates.
• Some discomfort or soreness at the incision site after the procedure, managed with pain relievers.
• Emotional reassurance knowing they have a device to prevent sudden cardiac arrest.