Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; multiple lead system
CPT4 code
Name of the Procedure:
Removal of Implantable Defibrillator Pulse Generator with Replacement of Implantable Defibrillator Pulse Generator (Multiple Lead System)
Summary
This procedure involves removing an old or faulty implantable defibrillator pulse generator and replacing it with a new one. The device, connected to multiple leads, helps regulate and correct abnormal heart rhythms.
Purpose
This procedure is performed to address malfunctioning or end-of-life implantable defibrillators. The goal is to ensure the patient continues to receive reliable life-saving electrical impulses to maintain a healthy heart rhythm.
Indications
- Malfunction of the current defibrillator pulse generator
- Battery depletion of the existing device
- Upgrade to a newer model for better performance
- Lead breakage or dysfunction necessitating generator replacement
Preparation
- Fasting for at least 6 hours before the procedure
- Adjusting or halting certain medications as advised by the physician
- Pre-procedure imaging tests such as X-rays or echocardiograms
- Blood tests for coagulation profiles and overall health assessment
Procedure Description
- The patient receives either local anesthesia with sedation or general anesthesia.
- An incision is made near the existing device's location.
- The old defibrillator pulse generator is carefully removed.
- Leads are inspected and tested; any faulty leads may be replaced.
- The new pulse generator is connected to the existing or new leads.
- The new device and leads are tested to ensure proper function.
- The incision is closed with sutures or surgical glue.
- A sterile dressing is applied over the surgical site.
Tools and Equipment
- Scalpel and surgical instruments
- Implantable cardioverter-defibrillator (ICD) device
- Lead testing and implant tools
- Sutures or surgical glue
Anesthesia
- Local anesthesia with sedative or general anesthesia
Duration
The procedure typically takes 1 to 3 hours.
Setting
The procedure is performed in a hospital's cardiac catheterization lab or an operating room.
Personnel
- Cardiac surgeon or electrophysiologist
- Anesthesiologist
- Surgical nurses
- Cardiac device technician
Risks and Complications
- Infection at the incision site
- Bleeding or hematoma formation
- Lead dislodgement or malfunction
- Anesthesia-related risks
- Rarely, damage to heart tissues or blood vessels
Benefits
- Restored or improved device function ensuring effective heart rhythm management
- Extended device lifespan
- Immediate correction of life-threatening arrhythmias
Recovery
- Monitoring in a recovery area for several hours post-procedure
- Pain management with medications
- Instructions for keeping the incision site clean and dry
- Avoiding strenuous activities for a few weeks
- Follow-up appointments to monitor device function and healing
Alternatives
- Medications to manage heart rhythm (though less effective for some patients)
- Ablation therapy, if suitable
- Observation, with close monitoring (typically less ideal for patients with significant history of arrhythmias)
Patient Experience
During the procedure, the patient will be under anesthesia and should not feel any pain. Post-procedure, the patient might experience mild discomfort or pain at the incision site, managed with pain medications. Full recovery usually spans a few weeks, with most daily activities resumed shortly after. Regular follow-up ensures the implanted device functions optimally.