Name of the Procedure:

Lead, left ventricular coronary venous system (C1900)

Summary

This procedure involves the placement of a lead (a thin wire) in the coronary veins of the left ventricle of the heart. The lead is used for pacing the heart in patients who have certain types of heart rhythm problems.

Purpose

This procedure addresses issues such as heart failure and certain types of arrhythmias (abnormal heart rhythms). The goal is to improve the heart's function and rhythm, thus alleviating symptoms and enhancing the patient's overall quality of life.

Indications

• Heart failure where conventional treatments are not sufficient.
• Specific types of arrhythmias, such as left bundle branch block (LBBB).
• Poor response to other forms of cardiac resynchronization therapy (CRT).
• Severe symptoms that impact daily activities despite optimal medical therapy.

Preparation

• Fasting for at least 8 hours before the procedure.
• Adjustments to medications as instructed by the healthcare provider (e.g., stopping blood thinners).
• Pre-procedure assessments like ECG, blood tests, and imaging studies (e.g., echocardiogram).

Procedure Description

1. Anesthesia: The patient is given local anesthesia and sometimes mild sedation to ensure comfort.
2. Venous Access: A catheter is inserted through a vein, usually in the groin or neck.
3. Lead Placement: Using fluoroscopic guidance (live X-ray), the lead is advanced through the catheter into the coronary venous system, targeting the left ventricle.
4. Lead Attachment: The lead is secured in place to ensure it remains stable and in the correct position.
5. Testing: The lead is tested to verify proper electrical activity and positioning.
6. Closure: The catheter is removed, and the insertion site is closed with sutures or adhesive bandages.

Duration

The procedure typically takes about 1 to 3 hours.

Setting

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

Personnel

• Cardiac electrophysiologist or interventional cardiologist.
• Nurses specialized in cardiac care.
• Radiologic technologist.
• Anesthesiologist or sedation nurse, if sedation is used.

Risks and Complications

• Common Risks: Bruising or bleeding at the insertion site, minor discomfort.
• Rare Risks: Infection, vein or heart damage, lead dislodgement, arrhythmias, blood clots.
• Management: Most complications can be managed with medications or additional procedures.

Benefits

• Improved heart function and efficiency.
• Alleviation of symptoms such as fatigue and shortness of breath.
• Enhanced quality of life and daily functioning.
• Benefits are typically realized within weeks to months post-procedure.

Recovery

• Monitoring in a recovery area for several hours post-procedure.
• Instructions on wound care and activity restrictions (e.g., avoiding heavy lifting for a few days).
• Follow-up appointments for lead assessment and potential adjustments.
• Gradual return to normal activities as advised by the healthcare provider.

Alternatives

• Medication: Management of symptoms with drugs alone.
• CRT-P or CRT-D devices: More complex cardiac resynchronization therapy devices.
• Surgical options: In severe cases, heart surgery or transplantation may be considered.
• Comparison: Medications may be less invasive but may not be as effective; surgical options are more invasive with longer recovery times.

Patient Experience

• During the Procedure: Minimal discomfort due to local anesthesia; mild sedation may help relaxation.
• After the Procedure: Some soreness at the insertion site, managed with pain relievers.
• Pain Management: Over-the-counter pain medications and comfort measures such as ice packs and rest.
• Overall Comfort: Measures are taken to ensure patient comfort throughout the process, with healthcare providers available for support.