CPT® Code 0572T

1. Indications

The insertion of a substernal implantable defibrillator electrode is indicated for patients who require an implantable cardioverter-defibrillator (ICD) but have limited venous access. This procedure is particularly suitable for individuals experiencing ventricular arrhythmias, where traditional ICD placement may not be feasible due to anatomical or physiological constraints.

• Ventricular Arrhythmias Patients experiencing life-threatening ventricular arrhythmias that necessitate the use of an ICD for rhythm management.
• Limited Venous Access Individuals who have anatomical challenges or conditions that restrict access to the venous system, making standard ICD implantation impractical.

2. Procedure

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

• Step 1: Incision and Access An incision is made in the subxiphoid space, which is located just below the sternum. Blunt dissection is performed through the diaphragmatic attachments to gain access to the substernal space, allowing for the placement of the electrode.
• Step 2: Tunneling Tool Placement A peel-away sheath is placed over a tunneling tool. Under fluoroscopic guidance, the tunneling tool is advanced from the substernal space medially to the left lateral border of the sternum, reaching the top of the cardiac silhouette.
• Step 3: Electrode Advancement Once the tunneling tool is in position, the sheath is advanced past the end of the tool, which is then removed. The electrode is then advanced through the sheath to the desired location within the substernal space.
• Step 4: Creation of Subcutaneous Pocket A separate incision is made in the left midaxillary region, where a subcutaneous pocket is created over the lateral rib cage to accommodate the ICD device generator.
• Step 5: Electrode Connection A subcutaneous tunnel is created from the pocket to the subxiphoid space, allowing the electrode to be threaded through this tunnel and connected to the pulse generator.
• Step 6: Device Programming and Testing The device is programmed and tested to ensure proper functionality. Adjustments to the electrode location may be made if necessary, followed by the removal of the sheath.
• Step 7: Closure of Incisions Finally, the incisions made in the subxiphoid and left axillary regions are closed to complete the procedure.

3. Post-Procedure

After the insertion of the substernal implantable defibrillator electrode, patients are typically monitored for any immediate complications. Post-procedure care may include pain management, wound care instructions, and follow-up appointments to assess the device's functionality and the patient's recovery. Patients should be advised on activity restrictions and signs of potential complications, such as infection or device malfunction, that warrant immediate medical attention.