Name of the Procedure:

Cardioverter-Defibrillator, Dual Chamber (Implantable) (HCPCS Code: C1721)

Common Names: Dual Chamber ICD, Implantable Cardioverter-Defibrillator (ICD).

Summary

A cardioverter-defibrillator is a small device implanted in the chest to help manage and treat irregular heartbeats (arrhythmias). The dual chamber ICD monitors the heart and delivers electrical shocks or pacing to correct life-threatening arrhythmias.

Purpose

This procedure addresses serious heart rhythm problems, notably situations where the heart beats too quickly (tachycardia) or too erratically (fibrillation). The primary goal is to prevent sudden cardiac arrest and improve the patient's quality of life by normalizing heart rhythms.

Indications

• Patients with a history of life-threatening arrhythmias.
• Those who have survived a sudden cardiac arrest.
• Individuals diagnosed with conditions that predispose them to dangerous arrhythmias, such as long QT syndrome or ventricular tachycardia.
• Patients with severe heart failure or cardiomyopathy at high risk for arrhythmias.

Preparation

• Fasting may be required several hours before the procedure.
• Adjustments to current medications (e.g., blood thinners) under doctor's advice.
• Pre-procedure assessments including an electrocardiogram (EKG), echocardiogram, blood tests, and possibly imaging studies like an MRI or CT scan.

Procedure Description

1. Preparation: The patient is prepped and brought to a sterile environment.
2. Anesthesia: Local anesthesia with sedation or general anesthesia may be administered.
3. Incision: A small incision is made near the collarbone (usually left side).
4. Lead Placement: Leads (thin, flexible wires) are threaded through a vein to the heart under X-ray guidance.
5. Device Implantation: The ICD device is implanted under the skin, connected to the leads.
6. Testing: The device is tested to ensure proper functioning.
7. Closure: The incision is closed with sutures or staples.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

Performed in a hospital setting, specifically in a cardiac electrophysiology lab or operating room.

Personnel

• Cardiologist specializing in electrophysiology or a cardiac surgeon.
• Surgical nurses.
• Anesthesiologist or nurse anesthetist.
• Radiologic technologist for imaging guidance.

Risks and Complications

• Infection at the implant site.
• Bleeding or bruising.
• Lead displacement.
• Pneumothorax (collapsed lung).
• Allergic reactions to medications or anesthesia.
• Rarely, device malfunction.

Benefits

• Prevention of sudden cardiac death.
• Improved management of life-threatening arrhythmias.
• Enhanced quality of life.
• Peace of mind for patients and their families.

Recovery

• Initial recovery in a hospital setting for monitoring, usually 1-2 days.
• Instructions to avoid heavy lifting or strenuous activities for several weeks.
• Keeping the incision area clean and dry to prevent infection.
• Regular follow-up appointments to check device function.
• Management of any new or persisting symptoms.

Alternatives

• Medications such as antiarrhythmics (beta-blockers, amiodarone).
• Ablation procedures to destroy abnormal heart tissue.
• Wearable defibrillators as temporary solutions.
• Pros and cons: Medications might not be as effective in preventing sudden death, and ablation might not address all types of arrhythmias.

Patient Experience

• During the procedure: Patients may feel pressure or tugging; sedation and local anesthetic minimize discomfort.
• Post-procedure: Some soreness near the incision, manageable with over-the-counter pain relief.
• Important to follow medical advice for care of the incision site and activity restrictions to ensure proper healing and device function. Comfort measures include rest and following medication regimens to manage pain and prevent infection.