CPT® Code 0321T

Deleted

1. Indications

The insertion of a subcutaneous implantable defibrillator pulse generator is indicated for patients who have an existing subcutaneous electrode and require an upgrade or replacement of the pulse generator component of their defibrillator system. This procedure is typically performed in cases where patients are at risk for life-threatening ventricular tachyarrhythmias, which necessitate the delivery of defibrillation therapy to restore normal heart rhythm.

• Life-threatening Ventricular Tachyarrhythmias Patients experiencing fast heart rhythms that pose a significant risk to their health and require immediate intervention.
• Existing Subcutaneous Electrode Patients who already have a subcutaneous electrode implanted and need a new pulse generator to continue effective monitoring and treatment of arrhythmias.

2. Procedure

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

• Preparation and Anesthesia The patient is placed under general anesthesia or monitored anesthesia care (MAC) along with local anesthesia to ensure comfort during the procedure. The surgical area, specifically the anterior and left lateral chest, is thoroughly prepped and draped to maintain a sterile environment.
• Incision for Pulse Generator An incision is made on the left lateral side of the chest, specifically between the 5th and 6th intercostal spaces 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 the xiphoid, extending horizontally towards the left lateral chest. This incision facilitates the insertion of the electrode.
• Electrode Tunneling Using an electrode insertion tool, the tripolar parasternal electrode is tunneled just below the skin along the rib line from the xiphoid to the subcutaneous pouch in the left chest. This step is crucial for ensuring the proper placement of the electrode.
• Distal Insertion Completion A small incision is made in the mid sternum to tunnel the distal tip of the electrode from the xiphoid to the superior sternum. This positions the distal sensing electrode next to the manubriosternal junction and the proximal sensing electrode next 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 monitor the device's response and functionality.
• Securing the Device After confirming the appropriate response of the device, the electrode and pulse generator are secured in place, and the incisions are closed to complete the procedure.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any immediate complications and ensuring the proper functioning of the newly implanted pulse generator. Patients are typically observed for signs of infection, bleeding, or device malfunction. Follow-up appointments are essential to assess the device's performance and make any necessary adjustments. Patients may also receive instructions regarding activity restrictions and care for the incision sites to promote healing and prevent complications.