Name of the Procedure:

Lead, Pacemaker, Transvenous VDD Single Pass (C1779)

• Common Names: Pacemaker Lead, Single-Pass VDD Lead
• Medical Term: Transvenous VDD Pacemaker Lead Implantation

Summary

The procedure involves inserting a specialized lead (a wire) into a vein leading to the heart to help regulate its rhythm. Unlike dual-lead systems, the single-pass VDD lead can sense and pace both the upper (atrium) and lower (ventricle) chambers of the heart using a single lead.

Purpose

• Conditions Addressed: Mainly used for heart rhythm disorders like atrioventricular (AV) block.
• Goals: To maintain a regular heart rhythm and improve cardiac function, reducing symptoms such as dizziness, fatigue, and fainting.

Indications

• Symptoms: Syncope (fainting), dizziness, fatigue, and palpitations.
• Conditions: AV block, symptomatic bradycardia (slow heart rate).
• Patient Criteria: Typically recommended for patients with AV block who can benefit from both atrial sensing and ventricular pacing.

Preparation

• Pre-Procedure Instructions: Patients may be asked to fast for 6-8 hours before the procedure. Certain medications (particularly blood thinners) might need to be adjusted.
• Diagnostic Tests: Electrocardiogram (ECG), echocardiogram, and blood tests to assess overall health and heart function.

Procedure Description

1. Anesthesia: Local anesthesia or light sedation is administered.
2. Insertion Site Preparation: A small incision is made near the collarbone.
3. Lead Insertion: The lead is threaded through a vein into the heart using fluoroscopic guidance (real-time X-ray).
4. Testing: The lead's position and function are tested to ensure proper pacing and sensing.
5. Connection: The lead is connected to the pacemaker device, which is then implanted under the skin.

Tools & Equipment: Fluoroscope, pacemaker lead, generator device, and surgical tools.

Duration

Typically, the procedure takes about 1 to 2 hours.

Setting

Performed in a hospital's electrophysiology or cardiac catheterization lab.

Personnel

• Cardiac Electrophysiologist or Cardiologist
• Nurses
• Radiologic Technologist
• Anesthesiologist (if deeper sedation is required)

Risks and Complications

• Common Risks: Infection at the incision site, bleeding or bruising, lead displacement.
• Rare Complications: Perforation of heart tissue, lung complications (e.g., pneumothorax), blood clots.

Benefits

• Expected Benefits: Regulation of heart rhythm, symptom relief (less dizziness, fatigue, and fainting).
• Timeframe: Benefits can often be noticed almost immediately after recovery from the procedure.

Recovery

• Post-Procedure Care: Monitoring in a hospital for 24 hours. Avoid strenuous activities and lifting heavy objects for several weeks.
• Recovery Time: Generally, 2-4 weeks for complete healing of the incision and adjustment to the device.
• Follow-Up: Regular follow-up appointments to monitor pacemaker function and battery life.

Alternatives

• Medications: Antiarrhythmic drugs, though they may be less effective for structural rhythm disorders.
• Other Devices: Dual-lead pacemakers, which involve placing leads in both atrium and ventricle, can offer more precise control for some patients.
• Pros and Cons: Single-pass VDD leads are less invasive but may be suitable only for specific types of heart blocks.

Patient Experience

• During Procedure: Mild discomfort from local anesthesia; consciousness maintained with possible light sedation.
• After Procedure: Some bruising and tenderness at the incision site. Patients may feel slight sensations from the new device initially, which usually subsides. Pain management includes over-the-counter pain relievers and resting.