CPT® Code 0799T

1. Indications

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

• Displacement of the Pacemaker The procedure may be necessary if the leadless pacemaker has moved from its original position, potentially affecting its functionality.
• Infection Conditions such as endocarditis, which is an infection of the heart's inner lining, may require the removal of the pacemaker to prevent further complications.
• Heart Failure If a patient develops heart failure and requires a cardiac resynchronization device, the existing leadless pacemaker may need to be removed 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 groin area is prepped and draped to maintain a sterile environment. Access to the femoral vein is achieved, allowing for the introduction of necessary instruments.
• Guidewire Placement A guidewire is inserted into the femoral vein to facilitate the placement of a femoral sheath, which is essential for the subsequent steps of the procedure.
• Venous Ultrasound Venous ultrasound may be performed to visualize the anatomy of the venous system, ensuring accurate placement of the sheath and guidewire.
• Sheath Placement and Dilation A femoral sheath is placed, and the vein is dilated incrementally to accommodate the retrieval instruments that will be used.
• Introducer Placement The leadless pacemaker retrieval introducer is placed into the vein, and the guidewire is removed to prepare for the retrieval catheter.
• Catheter Advancement Under fluoroscopy guidance, the retrieval catheter is advanced through the introducer, traveling 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 held before withdrawal.
• Second Retrieval Attempt 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 of Access Site After the successful removal of the pacemaker, the access site is closed to complete the procedure.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any complications that may arise from the removal of the pacemaker. Patients are typically observed for signs of bleeding or infection at the access site. Additionally, the patient's heart rhythm and overall cardiac function may be assessed to ensure stability following the procedure. Instructions regarding activity restrictions and follow-up appointments will be provided to ensure proper recovery and management of the patient's cardiac health.