CPT® Code 0307T

Deleted

1. Indications

The removal of an intracardiac ischemia monitoring device is indicated in specific clinical scenarios where the device is no longer needed or has become problematic. The following conditions may warrant this procedure:

• Device Replacement The patient may require a new monitoring device due to malfunction or technological advancements.
• Device Complications Issues such as infection, lead fracture, or other complications associated with the implanted device necessitate its removal.
• Resolution of Ischemic Events If the underlying condition that required monitoring has resolved, the device may be removed.
• Patient Preference Patients may choose to have the device removed for personal reasons or due to discomfort.

2. Procedure

The procedure for the removal of the intracardiac ischemia monitoring device involves several detailed steps to ensure safe and effective extraction:

• Step 1: Anesthesia Administration The procedure begins with the administration of monitored anesthesia care (MAC) or general anesthesia to ensure the patient is comfortable and pain-free during the operation.
• Step 2: Local Anesthetic Infiltration A local anesthetic is then infiltrated into the skin over the site of the implanted device to further minimize discomfort at the incision site.
• Step 3: Device Deactivation The implanted device is turned off using an external programmer, ensuring that it is no longer active during the removal process.
• Step 4: Incision Reopening The previous incision made during the device implantation is reopened carefully to access the device.
• Step 5: Scar Tissue Management The implanted monitoring device is freed from any scar tissue that may have formed around it, which may involve careful dissection to avoid damage to surrounding tissues.
• Step 6: Lead Wire Separation The lead wire connected to the device is separated from the implanted monitoring device, preparing it for removal.
• Step 7: Sheath Insertion A sheath is passed over the lead wire and is threaded down toward the heart, often utilizing fluoroscopy and/or ultrasound for guidance.
• Step 8: Scar Tissue Vaporization If necessary, the sheath may be equipped with a laser or electrocautery heating device to vaporize any scar tissue encountered along the lead wire's path.
• Step 9: Lead Wire Removal Once the lead wire is completely freed from scar tissue, it is removed along with the sheath, ensuring that all components of the device are extracted.
• Step 10: Alternative Removal Method An alternate method may involve passing a snare wire alongside the lead wire to the apex of the right ventricle, using the snare to free the tip of the lead wire and pulling it back through the vein with tension.
• Step 11: Incision Closure Finally, the incision is closed with sutures, ensuring proper healing and minimizing the risk of complications.

3. Post-Procedure

After the removal of the intracardiac ischemia monitoring device, patients are typically monitored for any immediate complications related to the procedure. Post-procedure care may include pain management, wound care instructions, and follow-up appointments to assess healing. Patients may be advised to avoid strenuous activities for a specified period to allow for proper recovery. Any signs of infection or unusual symptoms should be reported to the healthcare provider promptly. The overall recovery time may vary depending on the individual patient's health status and the complexity of the procedure.