Name of the Procedure:

Lead, Pacemaker, Other Than Transvenous VDD Single Pass (HCPCS C1898)

Summary

This procedure involves the implantation of a pacemaker lead that is not a transvenous VDD single pass lead. The lead is responsible for detecting the heart’s electrical activity and delivering electrical impulses to regulate the heartbeat.

Purpose

The procedure addresses heart rhythm disorders such as bradycardia, where the heart beats too slowly. The goal is to ensure the heart maintains a proper rhythm, improving overall heart function and patient well-being.

Indications

• Symptoms like dizziness, fatigue, or fainting due to slow heart rates.
• Diagnosed bradycardia or other heart rhythm problems.
• Patients unable to receive or tolerate transvenous VDD pacing leads.

Preparation

• Fasting for a specific period before the procedure (usually 6-8 hours).
• Adjustments to current medications as advised by the healthcare provider.
• Pre-procedure diagnostic tests like ECG, blood tests, or imaging studies.

Procedure Description

1. The patient receives local anesthesia and sedation.
2. A small incision is made near the collarbone.
3. The pacemaker lead is placed in the appropriate position, either on the heart or epicardium.
4. The lead connects to the pacemaker device, which is then implanted under the skin.
5. The system is tested to ensure proper function.
6. The incision is closed with sutures or staples.

Tools/Equipment Used:

• Pacemaker lead
• Pacemaker device
• Imaging equipment (e.g., fluoroscopy)
• Surgical instruments

Duration

The procedure typically takes between 1 to 2 hours.

Setting

This procedure is usually performed in a hospital operating room or a specialized cardiac catheterization lab.

Personnel

• Cardiac surgeon or electrophysiologist
• Anesthesiologist or nurse anesthetist
• Surgical nurse or technician
• Radiologic technologist (if imaging is used)

Risks and Complications

Common Risks:

• Infection at the incision site.
• Bleeding or bruising.
• Lead dislodgement or malfunction.

Rare Risks:

• Damage to blood vessels or heart tissue.
• Allergic reaction to anesthesia.
• Pacemaker malfunction.

Complications Management:

• Antibiotics for infections.
• Additional procedures to correct lead placement or device issues.

Benefits

• Improved heart rhythm and reduced symptoms of bradycardia.
• Enhanced quality of life with fewer episodes of dizziness or fainting.
• Immediate alignment of heart rhythm post-procedure, though full benefits might be realized over weeks.

Recovery

• Hospital stay of 1-2 days for monitoring.
• Activity restrictions, especially avoiding strenuous activities and lifting with the affected arm, for a few weeks.
• Follow-up appointments to check pacemaker function and overall health.
• Instructions on wound care and recognizing signs of infection.

Alternatives

• Transvenous pacemaker implantation.
• Medications to manage heart rhythm.

• Lifestyle and dietary changes to support heart health.

  Each alternative has its pros and cons; for instance, transvenous leads may offer easier implantation but may not be suitable for all patients.

Patient Experience

During the Procedure:

• The patient might feel slight discomfort from the local anesthesia injection.
• Minimal awareness of the procedure due to sedation.

After the Procedure:

• Mild pain or discomfort at the incision site.
• Instructions for medication to manage pain.
• Sensations of the pacemaker adjusting to heart rhythms may be felt temporarily.