Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; single lead system
CPT4 code
Name of the Procedure:
Removal of Implantable Defibrillator Pulse Generator with Replacement of Implantable Defibrillator Pulse Generator; Single Lead System
Summary
The procedure involves removing an old or malfunctioning implantable defibrillator pulse generator and replacing it with a new one. This type of defibrillator, which uses a single lead (wire), helps keep the heart beating regularly by providing electrical shocks when an abnormal rhythm is detected.
Purpose
This procedure is performed to replace a defibrillator that is no longer working correctly or has reached the end of its battery life. The goal is to ensure that the patient continues to have protection against life-threatening heart rhythms.
Indications
- Patients with existing implantable defibrillators requiring replacement due to battery depletion or device malfunction.
- Patients who have experienced complications with their current defibrillator.
- Manufacturer recalls or updates prompting a need for replacement.
Preparation
- Patients may be asked to fast for 6-8 hours before the procedure.
- Current medications may need adjustment or temporary discontinuation.
- Blood tests, chest X-rays, and ECGs may be performed prior to the procedure.
Procedure Description
- Anesthesia: Local anesthesia or conscious sedation is administered.
- Incision: A small incision is made near the site of the current defibrillator.
- Removal: The existing pulse generator is carefully disconnected and removed.
- Inspection: The single lead is inspected for functionality and integrity.
- Replacement: A new pulse generator is attached to the existing lead and implanted.
- Testing: The new device is tested to ensure proper operation.
- Closure: The incision is closed with sutures or adhesive.
Duration
The procedure generally takes about 1-2 hours to complete.
Setting
The procedure is typically performed in a hospital setting or a specialized outpatient surgical center.
Personnel
- Cardiologist or cardiac surgeon
- Registered nurses
- Anesthesiologist or nurse anesthetist
- Surgical technicians
Risks and Complications
- Infection at the incision site
- Bleeding or hematoma
- Damage to the lead or surrounding tissues
- Risk of blood clots
- Potential device malfunction
- Adverse reaction to anesthesia
Benefits
- Continued protection against sudden cardiac arrest.
- Extended battery life and improved device functionality.
- Enhanced quality of life and reduced risk of heart rhythm disturbances.
Recovery
- Patients may need to stay in the hospital for observation for a day.
- Post-procedure care includes keeping the incision site clean and dry.
- Avoid strenuous activities or heavy lifting for a few weeks.
- Follow-up appointments to monitor the new device's performance.
Alternatives
- External defibrillators as a temporary measure.
- Comprehensive medical management to stabilize heart rhythms.
Pros and Cons of Alternatives
External Defibrillators: Less invasive but not suitable for long-term use. Medical Management: Non-invasive but may not be as effective in preventing sudden cardiac arrest.
Patient Experience
During the procedure, patients will be under local anesthesia and may feel pressure but not pain. Post-procedure, patients may experience soreness at the incision site. Pain management includes prescribed medications and rest, and most patients return to routine activities within a week or two, avoiding strenuous exercises for a longer period as advised by their healthcare provider.