33285 Insertion, subcutaneous cardiac rhythm monitor, including programming

Name of the Procedure:

Insertion of Subcutaneous Cardiac Rhythm Monitor (Also known as Insertable Cardiac Monitor (ICM) or Implantable Loop Recorder (ILR))

Summary

The insertion of a subcutaneous cardiac rhythm monitor is a minimally invasive procedure where a small device is implanted under the skin of the chest to continuously monitor heart rhythms. This device helps in diagnosing irregular heartbeats or arrhythmias.

Purpose

This procedure is aimed at diagnosing unexplained fainting, palpitations, unexplained strokes, or other symptoms that may be linked to abnormal heart rhythms. The goal is to continuously monitor the heart over an extended period, providing data that can help in diagnosing and managing heart conditions.

Indications

• Unexplained fainting (syncope)
• Palpitations
• Dizziness
• Unexplained strokes or transient ischemic attacks (TIA)
• Suspected intermittent arrhythmias

Preparation

• Fasting for several hours prior to the procedure may be required.
• Adjustments to medications (such as anticoagulants) may be necessary.
• Pre-procedure diagnostic tests, such as an electrocardiogram (ECG) or blood tests, may be performed.

Procedure Description

1. The patient is placed in a comfortable position.
2. Local anesthesia is administered to numb the area where the device will be implanted.
3. A small incision (about 1-2 cm) is made on the upper chest.
4. The cardiac rhythm monitor is inserted under the skin through the incision.
5. The device is positioned and programmed to record heart rhythms according to the patient's specific needs.
6. The incision is closed with sutures or adhesive strips.
7. The device is tested to ensure it is working correctly.

Tools and equipment used include the cardiac rhythm monitor, local anesthetic, surgical knife, and suturing materials.

Duration

The procedure typically takes about 20 to 30 minutes.

Setting

The procedure is usually performed in an outpatient clinic, electrophysiology lab, or hospital setting.

Personnel

• Cardiologist or electrophysiologist
• Nurse or medical assistant
• Technician for device programming
• Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

• Infection at the implantation site
• Bleeding or bruising
• Pain or discomfort at the insertion site
• Allergic reaction to local anesthesia
• Device malfunction or displacement (rare)

Benefits

• Continuous, long-term monitoring of heart rhythms
• Accurate diagnosis of intermittent arrhythmias
• More targeted and effective treatment plans
• Potential to prevent serious complications like stroke

Recovery

• Mild pain or discomfort at the insertion site can be managed with over-the-counter pain relievers.
• Keep the incision site clean and dry for a few days.
• Limited physical activity may be recommended for the first week.
• Follow-up appointments will be scheduled to check the device and monitor the incision site.

Alternatives

• Holter monitor or external cardiac event recorder (short-term monitoring)
• Wearable heart monitors
• Electrocardiography (ECG), though it provides only a brief snapshot of heart activity

Pros and cons of alternatives vary; for instance, external monitors can be less invasive but may not capture sporadic events as effectively as an implantable device.

Patient Experience

• During the procedure, the patient will feel minimal discomfort due to local anesthesia.
• Post-procedure, the patient may experience mild pain or tenderness at the implantation site.
• Most patients can return to normal activities within a week, but should follow specific instructions provided by their healthcare provider.
• Regular follow-up appointments are crucial for monitoring device function and obtaining downloaded data.