Pacemaker, other than single or dual chamber (implantable)
HCPCS code
Name of the Procedure:
Pacemaker, other than single or dual chamber (implantable)
Technical Term: Biventricular Pacemaker or Cardiac Resynchronization Therapy (CRT) Device
Summary
A pacemaker is a small device implanted in the chest to help regulate abnormal heart rhythms. Unlike single or dual-chamber pacemakers that control either one or two chambers of the heart, a biventricular pacemaker is designed to coordinate contractions between the left and right ventricles, improving the efficiency of the heart.
Purpose
This procedure aims to treat heart failure and arrhythmias by synchronizing the contractions of the heart ventricles. The expected outcomes include improved heart function, reduced symptoms of heart failure, and overall enhanced quality of life.
Indications
- Chronic heart failure
- Weak heart muscles (cardiomyopathy)
- Ineffective heart pumping (ventricular dyssynchrony)
- Inadequate response to medication
- Symptoms include shortness of breath, fatigue, and fluid retention
Preparation
- Fasting typically for 6-8 hours before the procedure
- Adjustments or temporary discontinuation of certain medications
- Pre-procedure diagnostic tests, such as an electrocardiogram (ECG), echocardiogram, or blood tests
- Possible chest X-ray or CT scan
Procedure Description
- An intravenous (IV) line is set up for medication administration.
- The patient is given local anesthesia and mild sedation.
- A small incision is made near the collarbone.
- Leads (wires) are guided through veins into the heart's ventricles under X-ray guidance.
- The pacemaker device is implanted under the skin in the chest.
- Leads are connected to the pacemaker, and the device settings are adjusted.
- The incision is closed with sutures or staples.
Duration
The procedure typically takes 2-4 hours.
Setting
The procedure is performed in a hospital's electrophysiology lab or surgical center.
Personnel
- Cardiologist or Cardiac Electrophysiologist
- Supporting nurses
- Anesthesiologist or nurse anesthetist
- Radiology technician
Risks and Complications
- Common risks: infection, bruising or bleeding at the incision site, allergic reaction to anesthesia
- Rare risks: blood vessel damage, lead dislodgement, device malfunction, pneumothorax (collapsed lung)
- Management: Antibiotics can prevent infection, careful monitoring and possible corrective procedures for lead issues.
Benefits
- Improved heart function and symptom reduction
- Increased exercise capacity and energy
- Potential reduction in hospitalizations for heart failure
Recovery
- Patients may stay in the hospital for 1-2 days.
- Avoid vigorous activities or heavy lifting for a few weeks.
- Follow-up appointments to check the device and overall recovery.
- Monitor for signs of infection and report any unusual symptoms to the doctor.
Alternatives
- Medication management: Pros include non-invasiveness; cons may involve limited effectiveness.
- Single or dual chamber pacemaker: May be less effective for severe heart failure with ventricular dyssynchrony.
- Implantable cardioverter-defibrillator (ICD) alone: Does not provide synchronized pacing.
Patient Experience
During the procedure, mild discomfort from the incision and lead placement may be felt, but sedation and local anesthesia help manage pain. Post-procedure, patients might experience soreness and limited mobility around the incision site. Pain relief and comfort measures include prescribed painkillers and following post-op care instructions. The overall experience should lead to notable improvements in daily life and heart function over the following months.