CPT® Code 0801T

1. Indications

The transcatheter removal and replacement of a permanent dual-chamber leadless pacemaker is indicated for patients who require an upgrade or replacement of their existing pacemaker system due to battery depletion or device malfunction. This procedure is particularly relevant for individuals who have experienced issues with their current pacemaker, such as inadequate pacing, sensing problems, or other complications that necessitate intervention. The dual-chamber system is specifically designed for patients who need synchronized pacing of both the right atrium and right ventricle, making it suitable for those with specific cardiac rhythm disorders.

2. Procedure

The procedure begins with the preparation of the groin area, which is prepped and draped to maintain a sterile environment. Access to the femoral vein is achieved, and a guidewire is placed to facilitate the introduction of the necessary catheters. Venous ultrasound may be utilized to visualize the anatomy and ensure proper access. Following this, a femoral sheath is inserted, and the vein is dilated incrementally to accommodate the retrieval introducer. Once the introducer is in place, the guidewire is removed, and under fluoroscopic guidance, a retrieval catheter is advanced through the inferior vena cava into the right atrium. This catheter employs a snare technique to capture the existing leadless pacemaker securely. With the pacemaker captured, the retrieval catheter, along with the pacemaker, is withdrawn from the body.

Subsequently, the replacement process begins with the introduction of a steerable delivery catheter, which contains an integrated guide catheter and a preloaded replacement leadless pacemaker. This catheter is threaded through the introducer and advanced into the right atrium via the inferior vena cava. Once positioned, the new pacemaker is tested by sending signals from an external programmer to ensure it is functioning correctly. Mapping is performed to confirm accurate placement, and the leadless pacemaker is deployed and positioned securely against the endocardium. After deployment, the pacemaker is undocked but remains tethered to the delivery system. Various tests, including pacing capture threshold, impedance, and sensing tests, are conducted to verify the adequacy of the implantation site within the atrium. If necessary, any repositioning and retesting are performed before the tether is released, and the delivery catheter is withdrawn. This entire process is then repeated for the retrieval and replacement of the right ventricular component of the dual-chamber system.

3. Post-Procedure

After the completion of the transcatheter removal and replacement procedure, patients are typically monitored for any immediate complications or adverse reactions. Post-procedure care may include observation in a recovery area to ensure stable vital signs and proper pacemaker function. Patients may be advised on activity restrictions and follow-up appointments to assess the performance of the newly implanted pacemaker. It is essential to monitor for signs of infection at the access site and to ensure that the pacemaker is functioning correctly through regular device checks. Any necessary adjustments or programming of the pacemaker may be performed during follow-up visits to optimize its performance and ensure patient safety.