CPT® Code 0803T

1. Indications

The transcatheter removal and replacement of a permanent dual-chamber leadless pacemaker, as described by CPT® Code 0803T, is indicated in the following scenarios:

• Battery Depletion Replacement is performed when the battery life of the right ventricular component of the leadless pacemaker is depleted, necessitating a new device to maintain effective cardiac pacing.

2. Procedure

The procedure for the transcatheter removal and replacement of the right ventricular component of a dual-chamber leadless pacemaker involves several detailed steps:

• Step 1: 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 for the procedure.
• Step 2: Guidewire Placement A guidewire is placed into the femoral vein to facilitate the subsequent steps. This guidewire serves as a pathway for the introduction of other devices.
• Step 3: Imaging Guidance Venous ultrasound may be performed to visualize the anatomy of the venous system, ensuring accurate placement of the devices during the procedure.
• Step 4: Femoral Sheath Insertion A femoral sheath is placed into the vein, and dilation is performed incrementally to accommodate the retrieval and delivery catheters.
• Step 5: Retrieval Catheter Placement The leadless pacemaker retrieval introducer is placed into the vein, and the guidewire is removed. Under fluoroscopy, the retrieval catheter is advanced through the introducer and into the inferior vena cava, reaching the right atrium.
• Step 6: Pacemaker Capture The retrieval catheter captures the leadless pacemaker using a snare technique, ensuring a secure grip on the device for removal.
• Step 7: Withdrawal of the Pacemaker With the pacemaker securely captured, the retrieval catheter, along with the pacemaker, is withdrawn from the body.
• Step 8: Delivery Catheter Introduction The steerable delivery catheter, which contains an integrated guide catheter and the preloaded replacement leadless pacemaker, is threaded through the introducer and advanced into the right atrium.
• Step 9: Device Testing The new pacemaker is tested by sending signals from an external programmer to ensure it is functioning correctly. Mapping is performed to determine the optimal placement of the device.
• Step 10: Deployment The leadless pacemaker is deployed and positioned securely against the endocardium, ensuring proper contact for effective pacing.
• Step 11: Testing and Confirmation Pacing capture threshold, impedance, and sensing tests are conducted to confirm the adequacy of the implantation site within the atrium. Any necessary repositioning and retesting are performed to ensure optimal placement.
• Step 12: Finalization Once confirmed, the tether is released, and the delivery catheter is withdrawn. The process is then repeated for the retrieval and replacement of the right ventricular component of the dual-chamber leadless pacemaker.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any complications and ensuring that the newly implanted leadless pacemaker is functioning as intended. Patients may require follow-up appointments for device interrogation and programming adjustments. It is essential to assess the patient's recovery and the effectiveness of the pacing provided by the new device. Any signs of infection, hematoma, or other adverse effects at the access site should be closely monitored during the recovery period.