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Lead, pacemaker/cardioverter-defibrillator combination (implantable)
HCPCS code
#### Name of the Procedure:
Lead, Pacemaker/Cardioverter-Defibrillator Combination (Implantable)
#### Summary
This procedure involves implanting a device that combines a pacemaker and a cardioverter-defibrillator to help manage irregular heart rhythms. The device monitors heartbeats and delivers electrical pulses or shocks to correct any abnormal rhythms, helping to maintain a regular heartbeat.
#### Purpose
The lead, pacemaker/cardioverter-defibrillator combination is designed to treat cardiac arrhythmias, such as tachycardia (fast heart rate), bradycardia (slow heart rate), and fibrillation (irregular heartbeats). The procedure aims to prevent sudden cardiac arrest, improve symptoms, and enhance the quality of life for individuals with severe heart conditions.
#### Indications
- Severe heart failure
- Life-threatening arrhythmias
- Previous cardiac arrest
- Syncope (fainting) due to ventricular arrhythmias
- Risk of sudden cardiac death
#### Preparation
- Fasting for at least 6-8 hours before the procedure
- Adjustment or discontinuation of certain medications as advised by the physician
- Pre-procedure diagnostic tests like ECG, blood tests, and imaging studies
- Review of medical history and current health status
#### Procedure Description
1. Administer local anesthesia and sedation if necessary.
2. Make a small incision near the collarbone.
3. Insert leads (wires) into a vein and guide them to the heart using X-ray imaging.
4. Attach leads to the pacemaker/cardioverter-defibrillator device and secure it under the skin.
5. Test the device to ensure proper functioning.
6. Close the incision and apply a dressing.
#### Duration
The procedure usually takes about 1 to 2 hours.
#### Setting
The procedure is typically performed in a hospital or a surgical center with specialized cardiac facilities.
#### Personnel
- Cardiologist or cardiac surgeon
- Anesthesiologist or sedation nurse
- Surgical nurses and technologists
- Radiology technician
#### Risks and Complications
- Infection at the implant site
- Bleeding or bruising
- Lead displacement or malfunction
- Allergic reaction to anesthesia
- Rare risks: blood clot, lung injury, or damage to blood vessels
#### Benefits
- Reduced risk of sudden cardiac death
- Improved heart rhythm control
- Enhanced quality of life
- Immediate detection and correction of heart rhythm abnormalities
#### Recovery
- Monitoring in the hospital for 24-48 hours post-procedure
- Limited physical activity for a few weeks to allow healing
- Regular follow-up appointments to check device function
- Specific instructions regarding wound care and activity levels
#### Alternatives
- Medications to manage heart rhythm
- Standalone pacemaker or defibrillator
- Catheter ablation
Pros and cons vary, with some alternatives potentially offering less invasive options but maybe less effective in certain severe heart conditions.
#### Patient Experience
During the procedure, patients might feel some pressure or discomfort at the incision site but should not experience significant pain due to anesthesia. Post-procedure, mild soreness at the implant site is expected, manageable with pain relief medications. Patients should anticipate some activity restrictions and follow doctor’s instructions for optimal recovery.