33263 Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; dual lead system

Name of the Procedure:

Removal of Implanted Defibrillator Pulse Generator with Replacement of Implanted Defibrillator Pulse Generator; Dual Lead System

Summary

This procedure involves removing an existing implantable defibrillator pulse generator and replacing it with a new one. The system uses dual leads that help regulate the heart's rhythm and prevent sudden cardiac arrest.

Purpose

This procedure addresses issues with a malfunctioning or outdated defibrillator. The goal is to ensure the patient has a functional device to manage irregular heartbeats and prevent life-threatening arrhythmias.

Indications

• Malfunction or failure of the current defibrillator.
• Expired battery or depleted power source in the existing device.
• Upgrade to a newer model or improved technology.
• Infection or other complications at the implant site.

Preparation

• Fasting for at least 8 hours before the procedure.
• Discontinuing certain medications (as advised by the doctor).
• Pre-procedure testing such as blood work, ECG, and imaging studies.

Procedure Description

1. The patient is taken to the procedure room and given local anesthesia or sedation.
2. An incision is made near the site of the existing pulse generator.
3. The old pulse generator is carefully removed.
4. The leads (wires) are inspected and tested to ensure they are functional. If necessary, they are repositioned or replaced.
5. A new pulse generator is connected to the existing or new leads.
6. The new generator is tested to ensure proper function.
7. The incision is closed with sutures or adhesive strips.

Duration

The procedure typically takes 2 to 4 hours.

Setting

The procedure is performed in a hospital, surgical center, or specialized cardiac clinic.

Personnel

• Cardiologist or cardiac surgeon
• Anesthesiologist or anesthesia nurse
• Surgical nurses
• Radiology technician (if imaging is needed)

Risks and Complications

• Infection at the incision site
• Bleeding or bruising
• Damage to blood vessels or surrounding tissue
• Lead displacement or malfunction
• Potential for anesthesia-related complications

Benefits

• Improved management of heart rhythm disorders.
• Reduced risk of sudden cardiac arrest.
• Prolonged device life and enhanced functionality.
• Immediate benefits typically realized within days following the procedure.

Recovery

• Monitoring in a recovery room for a few hours to ensure stable heart rhythm and vitals.
• Possible overnight hospital stay for observation.
• Instructions to avoid strenuous activities for several weeks.
• Follow-up appointments to check device function and wound healing.

Alternatives

• Continued use of the existing device with periodic monitoring.
• Medication management to control arrhythmias.
• Alternative cardiac procedures like ablation or a heart transplant (in severe cases).
• Each alternative has specific pros and cons depending on the patient's condition and overall health.

Patient Experience

• Mild discomfort or pain at the incision site managed with pain relievers.
• Some swelling and bruising around the surgical area.
• Temporary restrictions on physical activities to allow proper healing.
• Gradual return to normal activities as advised by the physician.