Cardioverter-defibrillator, other than single or dual chamber (implantable)
HCPCS code
Name of the Procedure:
Common Names: Implantable Cardioverter Defibrillator (ICD), Cardioverter-Defibrillator Implant
Technical Terms: Cardioverter-defibrillator, other than single or dual chamber (HCPCS Code: C1882)
Summary
An implantable cardioverter-defibrillator (ICD) is a device placed under the skin to monitor heart rhythms and deliver electric shocks if dangerous arrhythmias are detected. This helps prevent sudden cardiac arrest.
Purpose
Medical Conditions: It addresses life-threatening arrhythmias such as ventricular tachycardia and ventricular fibrillation. Goals: The primary goal is to prevent sudden cardiac death by instantly correcting abnormal heart rhythms.
Indications
Symptoms and Conditions: Patients with heart conditions that predispose them to dangerous arrhythmias, such as prior heart attack, cardiomyopathy, or genetic heart disorders. Patient Criteria: Those with a high risk of sudden cardiac death, often evaluated by criteria such as ejection fraction and history of arrhythmic events.
Preparation
Pre-procedure Instructions: Patients may be instructed to fast for a certain period and adjust current medications, particularly those affecting blood clotting. Diagnostic Tests: Often includes echocardiogram, electrocardiogram (ECG), blood tests, and other heart function assessments.
Procedure Description
The procedure involves:
- Incision: A small incision is made near the collarbone.
- Lead Insertion: Leads (wires) are threaded through a vein into the heart.
- Device Placement: The ICD device is placed under the skin and connected to the leads.
- Testing: The device is tested to ensure it correctly identifies and treats arrhythmias. Tools/Equipment: ICD, leads, fluoroscopy (imaging to guide lead placement). Anesthesia: Local anesthesia with sedation, or general anesthesia in some cases.
Duration
The procedure typically takes 1 to 3 hours.
Setting
Performed in a hospital setting, often in a specialized cardiac catheterization lab or operating room.
Personnel
Involves a cardiologist or electrophysiologist, anesthesiologist, cardiac nurse, and possibly a surgical technologist.
Risks and Complications
Common Risks: Infection at the incision site, bleeding, bruising, lead displacement. Rare Risks: Hemothorax, pneumothorax, heart perforation, device malfunction. Complications Management: Close monitoring, antibiotics for infections, possible reoperation for lead issues.
Benefits
The ICD significantly reduces the risk of sudden cardiac death in high-risk patients, functioning instantly to correct life-threatening arrhythmias. Benefits are typically realized immediately, or shortly post-recovery.
Recovery
Post-procedure Care: Monitoring in a hospital room, instructions on wound care, activity restrictions to allow the leads to settle. Recovery Time: Generally, 1 to 2 weeks of restricted activity with regular follow-up appointments.
Alternatives
Other Treatments: Medications like antiarrhythmics, catheter ablation, or external defibrillators. Pros and Cons: Medications and ablation may not be as effective in preventing sudden cardiac death. External defibrillators are less convenient and require immediate access during an arrhythmia.
Patient Experience
During the procedure, patients will be under anesthesia with no pain felt. Post-procedure, patients may experience mild discomfort at the incision site and occasional muscle aches. Pain management usually includes over-the-counter pain relievers and prescribed medications if necessary. Comfort measures like ice packs and rest are recommended.