CPT® Code 0320T

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1. Indications

The insertion of a subcutaneous defibrillator electrode is indicated for patients who are at risk of life-threatening ventricular tachyarrhythmias. This includes individuals with a history of cardiac arrhythmias that may lead to sudden cardiac arrest or those who have been diagnosed with conditions that predispose them to such arrhythmias.

• Life-threatening Ventricular Tachyarrhythmias Patients experiencing fast heart rhythms that can lead to severe complications, including sudden cardiac arrest.
• Cardiac Arrhythmias Individuals with a documented history of abnormal heart rhythms that require monitoring and potential intervention.

2. Procedure

The procedure for the insertion of a subcutaneous defibrillator electrode involves several critical steps to ensure proper placement and functionality of the device.

• Preparation The patient is positioned appropriately and prepped for surgery. The anterior and left lateral chest areas are cleaned and draped to maintain a sterile environment. Anesthesia is administered, which may include general anesthesia or monitored anesthesia care (MAC) along with local anesthesia.
• Incision for Pulse Generator An incision is made on the left lateral side of the chest, specifically between the 5th and 6th intercostal space along the mid-axillary line. This incision allows for the creation of a subcutaneous pouch where the pulse generator will be placed.
• Incision for Electrode Insertion The surgeon locates the tip of the xiphoid process at the base of the sternum and makes a midline incision at this point, extending horizontally toward the left lateral chest. This incision facilitates the tunneling of the electrode.
• Tunneling the Electrode Using an electrode insertion tool, the tripolar parasternal electrode is tunneled just beneath the skin along the rib line from the xiphoid to the subcutaneous pouch created in the left chest. This step is crucial for ensuring that the electrode is positioned correctly for optimal sensing and shocking capabilities.
• Distal Insertion Completion A small incision is made in the mid sternum to complete the distal insertion of the electrode. The distal tip of the electrode is tunneled from the xiphoid to the superior sternum, positioning the distal sensing electrode next to the manubriosternal junction and the proximal sensing electrode adjacent to the xiphoid process, with the shocking coil situated between these two points.
• Connection and Testing The electrode is then connected to the pulse generator, which is placed into the subcutaneous pouch in the left chest area. The pulse generator is programmed externally, and an arrhythmia is induced to test the device's response. The patient is monitored closely during this phase to ensure the device functions as intended.
• Securing and Closing Incisions Once the electrode and device are confirmed to be functioning properly, they are secured in place. The incisions made during the procedure are then closed to complete the surgical intervention.

3. Post-Procedure

After the insertion of the subcutaneous defibrillator electrode, the patient is monitored for any immediate complications and to ensure the device is functioning correctly. Post-procedure care may include pain management, monitoring for signs of infection at the incision sites, and ensuring the patient understands the device's function and any necessary follow-up appointments. Recovery time may vary, but patients are typically advised to avoid strenuous activities for a specified period to allow for proper healing.