CPT® Code 0800T

1. Indications

Indications for the transcatheter removal of a permanent dual-chamber leadless pacemaker include the following:

• Displacement of the Pacemaker The device may have shifted from its intended position, necessitating removal.
• Infection Conditions such as endocarditis may arise, requiring the pacemaker to be removed to prevent further complications.
• Heart Failure Patients who develop heart failure may need the leadless pacemaker removed to facilitate the placement of a cardiac resynchronization device, which helps coordinate the contractions of both ventricles.

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, typically using a needle to puncture the vein.
• 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.
• Retrieval Introducer Placement The leadless pacemaker retrieval introducer is inserted into the vein, and the guidewire is removed, allowing for the next steps in the retrieval process.
• Catheter Advancement Under fluoroscopic 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 captured.
• Withdrawal of the Retrieval Catheter Once the pacemaker is captured, the retrieval catheter, along with the pacemaker, is withdrawn from the body.
• Second Retrieval Attempt The process is repeated by placing the retrieval catheter through the femoral vein a second time to access the right atrium, where the right atrial pacemaker component is captured and removed.
• Closure of Access Site After the removal of both components, the access site is closed to complete the procedure.

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 should be provided to ensure proper recovery and management of any underlying conditions that necessitated the removal of the pacemaker.