CPT® Code 0798T

1. Indications

The transcatheter removal of a permanent dual-chamber leadless pacemaker is indicated in specific clinical scenarios, including:

• Displacement of the Pacemaker The procedure may be necessary if the leadless pacemaker has moved from its intended position within the heart, potentially affecting its functionality.
• Infection Conditions such as endocarditis, which is an infection of the heart's inner lining, may necessitate the removal of the pacemaker to prevent further complications.
• Heart Failure In patients who develop heart failure and require a cardiac resynchronization device, the removal of the existing dual-chamber leadless pacemaker may be required to facilitate the new device's placement.

2. Procedure

The procedure for the transcatheter removal of a permanent dual-chamber leadless pacemaker involves several critical steps:

• Preparation and Access The patient is positioned appropriately, and the groin area is prepped and draped to maintain a sterile environment. Access to the femoral vein is achieved, typically through a small incision.
• Guidewire Placement A guidewire is inserted into the femoral vein to facilitate the subsequent placement of a sheath. This step may be aided by venous ultrasound to visualize the anatomy and ensure proper placement.
• Sheath Insertion and Dilation A femoral sheath is placed into the vein, and dilation is performed incrementally to accommodate the retrieval introducer. This step is crucial for ensuring that the introducer can be navigated through the venous system.
• Retrieval Catheter Placement The leadless pacemaker retrieval introducer is placed into the vein, and the guidewire is removed. Under fluoroscopic guidance, the retrieval catheter is advanced through the inferior vena cava into the right atrium and then through the tricuspid valve into the right ventricle.
• Pacemaker Capture The catheter employs a snare technique to capture the leadless pacemaker securely. Fluoroscopy is utilized to confirm that the mechanism is fully engaged and that the pacemaker is securely captured before proceeding with withdrawal.
• Second Retrieval The process is repeated by placing the retrieval catheter through the femoral vein a second time, advancing it to the right atrium to capture and remove the right atrial pacemaker component.
• Closure After the successful removal of both components of the dual-chamber leadless pacemaker, the access site is closed appropriately to ensure proper healing.

3. Post-Procedure

Post-procedure care involves 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 following the removal of the pacemaker. Instructions regarding activity restrictions and follow-up appointments will be provided to ensure proper recovery and assessment of the patient's cardiac status. It is essential to monitor the patient closely for any signs of complications related to the procedure or the underlying conditions that necessitated the pacemaker's removal.