CPT® Code 0526T

1. Indications

The intracardiac ischemia monitoring system is indicated for patients with a prior history of acute coronary syndrome, which includes:

• Myocardial Infarction (MI) A condition where blood flow to a part of the heart is blocked, causing damage to the heart muscle.
• Unstable Angina A type of chest pain that occurs unpredictably and may signal an impending heart attack.
• High Risk for Recurrent Events Patients who are at increased risk for further cardiac events due to their medical history.

2. Procedure

The procedure for the insertion or replacement of the intracardiac ischemia monitoring system electrode involves several critical steps:

• Step 1: Venous Access The first step involves obtaining venous access, which can be performed using a standard percutaneous puncture of the subclavian vein or through a cut down technique to access the cephalic vein. This access is essential for the subsequent placement of the EKG electrode.
• Step 2: Guidewire Insertion Under fluoroscopic guidance, a guidewire is inserted into the chosen vessel and advanced toward the right ventricle. This step is crucial for ensuring that the electrode can be accurately positioned within the heart.
• Step 3: Vascular Sheath Introduction A vascular sheath is then introduced over the guidewire into the right ventricle. Once the sheath is in place, the guidewire is removed, allowing for the next step of electrode placement.
• Step 4: EKG Electrode Placement The EKG electrode is threaded through the sheath and tested to ensure it captures cardiac electrical impulses effectively. This testing is vital to confirm that the electrode is functioning properly before final placement.
• Step 5: Electrode Anchoring Once the optimal placement of the electrode is confirmed, it is anchored to the endocardium. The vascular sheath is then removed, and to prevent migration of the electrode, the electrode wire may be sutured in place at the vessel insertion site.
• Step 6: Monitor Pocket Creation A skin incision is made in the infraclavicular area to create a subcutaneous pocket for the monitor. This pocket will house the monitoring device securely beneath the skin.
• Step 7: Monitor Connection and Insertion The EKG electrode is connected to the monitor, which is then tested and programmed to ensure it operates correctly. Finally, the monitor is inserted into the created pocket beneath the skin, completing the procedure.

3. Post-Procedure

After the procedure, patients are typically monitored for any immediate complications related to the insertion of the electrode and the monitor. It is essential to ensure that the device is functioning correctly and that the patient understands how to respond to alarms from the monitoring system. Follow-up appointments may be scheduled to assess the device's performance and the patient's overall cardiac health. Additionally, patients should be educated on the signs of potential complications, such as infection at the insertion site or device malfunction, and instructed to seek medical attention if they experience any concerning symptoms.