CPT® Code 0388T

Deleted

1. Indications

The transcatheter removal of a permanent leadless pacemaker is indicated for patients who require the extraction of the device due to various clinical reasons. These may include:

• Device malfunction - Situations where the pacemaker is not functioning as intended, leading to inadequate pacing or other complications.
• Infection - The presence of infection at the site of the pacemaker or systemic infection that necessitates removal of the device.
• Patient's clinical condition change - Changes in the patient's health status that may require the discontinuation of pacing therapy.
• Device upgrade - Instances where a newer model or different type of pacing device is needed for improved patient management.

2. Procedure

The procedure for the transcatheter removal of a permanent leadless pacemaker involves several critical steps to ensure safe and effective extraction of the device. The following steps outline the process:

• Step 1: Accessing the femoral vein - The procedure begins with the patient positioned appropriately, and the femoral vein is accessed using either a percutaneous approach or a cut down technique. This access point is crucial for the subsequent steps of the procedure.
• Step 2: Upsizing the access - Once the femoral vein is accessed, the vein is upsized to accommodate a large diameter sheath, which is necessary for the delivery of the snare system used to grasp the pacemaker.
• Step 3: Advancing the sheath - The sheath is carefully advanced through the femoral vein and navigated to the apex of the right ventricle, where the leadless pacemaker is located.
• Step 4: Delivering the snare system - A catheter-based snare system is then delivered through the sheath into the right ventricle. This specialized tool is designed to grasp the pacemaker securely.
• Step 5: Grasping the pacemaker - The snare is maneuvered to grasp the leadless pacemaker, ensuring a firm hold on the device for safe removal.
• Step 6: Withdrawing the device - Once the pacemaker is securely grasped, it is withdrawn through the sheath, effectively removing it from the patient's body.
• Step 7: Closing the incision - After the pacemaker has been successfully removed, the sheath is taken out, and the incision site is closed to complete the procedure.

3. Post-Procedure

Post-procedure care following the transcatheter removal of a permanent leadless pacemaker includes monitoring the patient for any immediate complications, such as bleeding or infection at the access site. Patients may be observed for signs of arrhythmias or other cardiac issues that could arise after the removal of the pacing device. Instructions regarding activity restrictions and follow-up appointments should be provided to ensure proper recovery. Additionally, any necessary imaging or assessments may be scheduled to evaluate the patient's cardiac status following the procedure.