CPT® Code 0303T

Deleted

1. Indications

The intracardiac ischemia monitoring system is indicated for use in patients who are at high risk for ischemic cardiac events. The following conditions and symptoms warrant the consideration of this monitoring system:

• Previous Acute Coronary Events Patients with a history of acute coronary syndromes are at increased risk for subsequent ischemic events, making monitoring essential for timely intervention.
• Diabetes Individuals with diabetes often have an increased risk of cardiovascular complications, including silent ischemia, which may not present with typical symptoms.
• Renal Insufficiency Patients with renal insufficiency may have altered cardiovascular responses and are at a higher risk for ischemic events, necessitating close monitoring.

2. Procedure

The procedure for the insertion, removal, and replacement of the electrode of the intracardiac ischemia monitoring system involves several critical steps:

• Step 1: Preparation The procedure begins with the patient being positioned appropriately in the cardiac catheterization lab. Monitored anesthesia care (MAC) or moderate sedation is administered to ensure patient comfort during the procedure. A local anesthetic is injected into the upper left chest area to minimize discomfort at the incision site.
• Step 2: Incision The physician makes a small skin incision, typically 2-3 inches long, in the upper left chest to access the underlying tissues and veins. This incision allows for the insertion of the lead wire and the monitoring device.
• Step 3: Lead Wire Insertion Using fluoroscopic guidance, the physician carefully advances the right ventricular lead wire through a vein to the apex of the right ventricle. This step is crucial for ensuring proper placement of the lead wire for effective monitoring.
• Step 4: Device Connection and Programming Once the lead wire is in place, it is connected to the programmable implantable monitoring device (IMD). The IMD is then programmed to establish baseline parameters for monitoring the patient's electrocardiogram (ECG) readings.
• Step 5: Device Insertion and Testing After programming, the IMD is inserted into the chest incision. The device is tested to ensure it is functioning correctly and is capable of detecting any deviations from the programmed baseline.
• Step 6: Closure Once testing is complete and the device is confirmed to be operational, the physician closes the skin incision with sutures, ensuring proper healing and minimizing the risk of infection.

3. Post-Procedure

After the procedure, patients are typically monitored for a short period to ensure there are no immediate complications. They may be advised on care for the incision site, including keeping it clean and dry. Patients should be educated on the function of the monitoring device, including how the external alarm device (EXD) operates and what to do if an alarm is triggered. Follow-up appointments will be necessary for the physician to retrieve and analyze data from the device, ensuring ongoing assessment of the patient's cardiac health. Additionally, patients should be informed about signs and symptoms that warrant immediate medical attention, reinforcing the importance of the monitoring system in managing their cardiac risk.