CPT® Code 0517T

1. Indications

The insertion of a wireless cardiac stimulator for left ventricular pacing is indicated for patients who may benefit from enhanced cardiac resynchronization therapy (CRT). The following conditions may warrant this procedure:

• Inadequate CRT Patients who have not achieved optimal cardiac resynchronization with conventional pacing methods may require this advanced approach to improve heart function.
• Anatomic challenges Individuals with anatomical issues that complicate the placement of traditional LV pacing leads may find this wireless solution beneficial.
• Lead dislodgment Patients experiencing dislodgment of conventional pacing leads, which can lead to ineffective therapy, may be candidates for this procedure.
• Unintended nerve stimulation Those who have experienced unintended nerve stimulation from conventional leads may require a wireless device to mitigate this issue.
• Need for repositioning Patients who have undergone previous lead placements that necessitate extraction and repositioning may benefit from the wireless approach.

2. Procedure

The procedure for the insertion of a wireless cardiac stimulator involves several detailed steps to ensure proper placement and functionality of the device:

• Step 1: Surgical Incision A surgical incision is made in the left anterior chest to create a subcutaneous pocket for the transmitter. This incision is typically located in the mid-axillary line, lateral to the parasternal border, within the 4th to 6th intercostal spaces.
• Step 2: Imaging Assessment Transthoracic echocardiography may be performed to evaluate the acoustic window, ensuring that there is no interference from bone or lung tissue that could affect communication between the external transmitter and the implanted electrode.
• Step 3: Transmitter Insertion The transmitter is inserted into the created pocket and secured with sutures to ensure stability.
• Step 4: Battery Pocket Creation A second incision is made adjacent to the transmitter pocket to create another subcutaneous pocket for the battery. A tunnel is fashioned between the two pockets for the connecting cable.
• Step 5: Battery Insertion The battery is inserted into its pocket, connected to the transmitter via the cable, and secured with sutures.
• Step 6: Vascular Access Percutaneous vascular access is established in a groin vessel to facilitate the retrograde delivery of the pacing electrode.
• Step 7: Electrode Placement Using standard catheterization techniques, the pacing electrode is advanced through the sheath to a position within 5-10 mm of the tip. Multiple locations within the ventricle are tested to identify the optimal site for electrical pacing.
• Step 8: Electrode Deployment The tiny receiver electrode is deployed and anchored into the ventricular endocardium, ensuring secure placement for effective pacing.
• Step 9: Device Interrogation and Programming Finally, the devices are interrogated and programmed to ensure optimal function and synchronization with the conventional pacemaker.

3. Post-Procedure

After the procedure, patients may require monitoring to assess the functionality of the wireless cardiac stimulator. Expected recovery includes observation for any complications related to the surgical incisions and the proper functioning of the device. Patients may be advised on activity restrictions and follow-up appointments for device interrogation and programming adjustments. It is essential to ensure that the pacing system is effectively synchronized and that the patient is responding positively to the therapy.