Name of the Procedure:

Pacemaker, Single Chamber, Rate-Responsive (Implantable)
Common Name(s): Single-Chamber Pacemaker, Rate-Responsive Pacemaker
Technical/Medical Term: Implantable Rate-Responsive Single-Chamber Pacemaker (HCPCS Code: C1786)

Summary

This procedure involves the implantation of a single-chamber pacemaker that adjusts its pacing rate based on the patient's physical activity. The device monitors the heart's rhythm and provides electrical stimulation when needed to maintain an appropriate heart rate.

Purpose

Medical Conditions or Problems Addressed

• Bradycardia (abnormally slow heart rate)
• Heart Block (a type of arrhythmia)
• Syncope (fainting episodes)

Goals and Expected Outcomes

• Maintains a stable heart rate
• Improves symptoms of dizziness and fatigue
• Reduces risk of fainting and related complications

Indications

Specific Symptoms or Conditions

• Frequent episodes of bradycardia
• Symptoms like fatigue, dizziness, or fainting related to slow heart rate
• Diagnosed heart arrhythmias that affect heart rate

Patient Criteria

• Patients with confirmed bradycardia
• Individuals with certain types of heart block
• Candidates who are unresponsive to or unsuitable for medication management

Preparation

Pre-procedure Instructions

• Fasting for at least 6-8 hours before the procedure
• Adjustments to current medications as directed by the doctor
• Preoperative diagnostic tests, including ECG, blood tests, and chest x-rays

Procedure Description

Detailed Steps

1. Anesthesia Administration: Local anesthesia and sedation, or general anesthesia depending on the patient's condition.
2. Incision: A small incision is made in the chest, just beneath the collarbone.
3. Lead Insertion: A lead (a thin, insulated wire) is inserted into a vein and guided to the heart.
4. Device Placement: The other end of the lead is connected to the pacemaker, which is placed in a small pocket under the skin.
5. Testing and Adjustment: The pacemaker's settings are tested and adjusted to ensure proper function.
6. Closure: The incision is closed with stitches and covered with a sterile dressing.

Tools, Equipment, or Technology

• Fluoroscopy (real-time x-ray imaging)
• Pacemaker device with rate-responsive technology
• Leads and insertion tools

Anesthesia or Sedation

• Local anesthesia with sedation, or
• General anesthesia if required

Duration

• The procedure typically takes 1 to 2 hours.

Setting

• Performed in a hospital or specialized surgical center.

Personnel

• Cardiologist (specializing in electrophysiology)
• Surgeons
• Nurses and surgical assistants
• Anesthesiologists

Risks and Complications

Common Risks

• Infection at the incision site
• Bleeding or swelling
• Pain or discomfort around the pacemaker site

Rare Risks

• Lead dislodgement or malfunction
• Allergic reaction to anesthesia
• Pneumothorax (collapsed lung)

Possible Complications

• Device malfunction, requiring reprogramming or replacement
• Heart perforation during lead placement

Benefits

• Improved heart rate regulation
• Reduction in bradycardia-related symptoms
• Increased ability to engage in physical activities

Timeframe for Benefits

• Most patients notice symptom improvement within days to weeks after implantation.

Recovery

Post-procedure Care

• Limited arm movements to allow healing of the surgical site
• Pain management with prescribed medications
• Keeping the incision site clean and dry

Recovery Time

• Typically, 4-6 weeks for full recovery.
• Follow-up appointments for device checks and adjustments.

Alternatives

Other Treatment Options

• Dual-Chamber Pacemaker
• Medication management
• Cardiac resynchronization therapy (CRT)

Pros and Cons of Alternatives

• Dual-Chamber Pacemaker: Offers improved heart rate regulation but more complex implantation.
• Medication: Non-invasive but may be less effective for severe bradycardia.
• CRT: Useful for heart failure patients but is typically more invasive.

Patient Experience

During the Procedure

• The patient might feel pressure but not pain if local anesthesia is used.
• General anesthesia patients will be unconscious and unaware during the procedure.

After the Procedure

• Mild to moderate discomfort at the implantation site.
• Pain management with medications and comfort measures.
• Temporary restrictions on physical activity to promote healing.