33275 Transcatheter removal of permanent leadless pacemaker, right ventricular, including imaging guidance (eg, fluoroscopy, venous ultrasound, ventriculography, femoral venography), when performed

Name of the Procedure:

Transcatheter Removal of Permanent Leadless Pacemaker, Right Ventricular
Common Name(s): Leadless Pacemaker Removal

Summary

This procedure involves removing a permanent leadless pacemaker from the right ventricle of the heart using a catheter. Imaging techniques like fluoroscopy and venous ultrasound guide the removal process.

Purpose

This procedure is performed to address complications associated with a leadless pacemaker, such as device malfunction, infection, or patient discomfort. The goal is to safely remove the pacemaker to restore normal cardiac function or to prepare for the placement of a new device.

Indications

• Device malfunction or failure
• Infection at the pacemaker site
• Complications such as thrombosis or perforation
• Patient experiencing significant discomfort or pain

Preparation

• Patients may be instructed to fast for 6-8 hours before the procedure.
• Medication adjustments may be necessary, especially if taking anticoagulants.
• Pre-procedure assessments include an EKG, blood tests, and imaging like echocardiography or chest X-ray.

Procedure Description

1. Patient is positioned and prepped in a sterile environment.
2. Local anesthesia is administered at the insertion site, usually the femoral vein.
3. A catheter is inserted into the femoral vein and guided to the right ventricle using imaging guidance like fluoroscopy.
4. The pacemaker is carefully disengaged from the heart tissue and retracted through the catheter.
5. Imaging checks ensure the procedure is complete.
6. The catheter is removed, and the insertion site is closed and bandaged.

Duration

The procedure typically takes 1 to 2 hours.

Setting

This procedure is usually performed in a hospital, specifically in a cardiac catheterization lab or an interventional radiology suite.

Personnel

• A cardiologist specialized in electrophysiology
• Interventional radiologist (if involved)
• Nurses and radiology technicians
• Anesthesiologist or sedation nurse

Risks and Complications

• Infection at the insertion site
• Bleeding or hematoma
• Thrombosis (blood clot formation)
• Damage to blood vessels or heart tissue
• Rarely, pacemaker components may break and require surgical intervention

Benefits

• Relief from symptoms caused by pacemaker malfunction or infection
• Reduced risk of ongoing complications
• Improved overall cardiac function

Recovery

• Patients may need to stay for monitoring overnight in the hospital.
• Activity may be restricted for a few days to prevent bleeding at the insertion site.
• Follow-up appointments will be arranged to monitor heart function and ensure the patient is recovering well.

Alternatives

• Medication management for minor pacemaker-related issues
• Invasive surgical removal if transcatheter removal is not feasible
• Watchful waiting in cases where immediate removal is not critical

Patient Experience

• Patients may experience mild discomfort or pressure during the insertion and removal of the catheter.
• Pain management includes local anesthesia and possible sedation.
• Post-procedure, patients may feel soreness at the insertion site, which can be managed with over-the-counter pain relievers and rest.