93640 Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implant

Name of the Procedure:

Electrophysiologic Evaluation of Single or Dual Chamber Pacing Cardioverter-Defibrillator Leads including Defibrillation Threshold Evaluation

Summary

This procedure involves testing the leads of a newly implanted pacemaker or defibrillator to ensure they are correctly detecting and treating irregular heart rhythms. The testing includes inducing arrhythmias and verifying that the device can accurately sense and terminate them.

Purpose

This procedure addresses issues related to abnormal heart rhythms (arrhythmias). The goals are to confirm proper placement and functioning of the device leads, and to make sure the device can correctly detect and respond to life-threatening arrhythmias.

Indications

• Patients requiring a new pacemaker or defibrillator implant.
• Individuals with heart conditions that predispose them to dangerous arrhythmias.
• Patients with a history of sudden cardiac arrest or significant ventricular arrhythmias.

Preparation

• The patient may be instructed to fast for several hours before the procedure.
• Certain medications, especially blood thinners or anti-arrhythmic drugs, may need to be adjusted or paused.
• Pre-procedure assessments might include an ECG, blood tests, and imaging studies like a chest X-ray or echocardiogram.

Procedure Description

1. The patient is given local anesthesia and possibly light sedation.
2. A small incision is made to implant the pacing cardioverter-defibrillator (ICD) device and leads.
3. Once the device is in place, electrophysiologic evaluation begins. This includes:
   • Inducing controlled arrhythmias to test the device's ability to detect them.
   • Checking the defibrillation threshold to ensure the device can effectively terminate dangerous arrhythmias.
   • Evaluating the device's sensing and pacing capabilities for both atrial and ventricular chambers.
4. Adjustments are made to the device settings based on the evaluation results.
5. The incision is closed, and the device is secured beneath the skin.

Duration

The procedure typically takes about 2 to 4 hours.

Setting

This procedure is performed in a hospital, specifically in a cardiac catheterization lab or electrophysiology lab.

Personnel

• Cardiologist or electrophysiologist (specialist in heart rhythm disorders)
• Surgical nurses and technicians
• Anesthesiologist or sedation nurse

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma formation
• Lead displacement or malfunction
• Arrhythmias induced during testing might not terminate as expected
• Rarely, damage to heart tissues or blood vessels

Benefits

• Ensures the pacemaker or defibrillator is correctly implanted and functioning.
• Provides peace of mind that the device will effectively manage life-threatening arrhythmias.
• Reduces the risk of sudden cardiac events through reliable heart rhythm management.

Recovery

• The patient might stay overnight in the hospital for monitoring.
• Instructions will include wound care, activity restrictions, and pain management.
• Follow-up appointments are essential to monitor device function and make any necessary adjustments.
• Full recovery usually takes a few weeks, during which time heavy physical activity should be avoided.

Alternatives

• Medication management alone, which may not be as effective for severe arrhythmias.
• Wearable external defibrillators, though less convenient and comfortable.
• Continued cardiology monitoring with periodic non-invasive evaluations.

Patient Experience

• Mild discomfort at the incision site and some pain for a few days post-procedure, manageable with pain relief medications.
• The sensation of the device functioning might be noticeable but not usually painful.
• Daily activities can typically be resumed gradually, with full return to normal activities within a few weeks.
• Psychological reassurance from having a reliable safeguard against dangerous heart rhythms.