CPT® Code 0824T

1. Indications

The transcatheter removal of a permanent single-chamber leadless pacemaker is indicated in the following situations:

• Displacement The leadless pacemaker may become displaced from its intended position within the right atrium, necessitating its removal.
• Infection Conditions such as endocarditis can arise, leading to the need for the pacemaker's removal to prevent further complications.
• Heart Failure Patients who develop heart failure may require the placement of a cardiac resynchronization device, which necessitates the removal of the existing leadless pacemaker.

2. Procedure

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

• Preparation The groin area is prepped and draped to maintain a sterile environment. This is essential to prevent infection during the procedure.
• Accessing the Femoral Vein The femoral vein is accessed, which serves as the entry point for the retrieval instruments. A guidewire is placed to facilitate this access.
• Venous Ultrasound Venous ultrasound may be performed to visualize the anatomy of the venous system, ensuring accurate placement of the instruments.
• Placement of Femoral Sheath A femoral sheath is inserted into the vein, and dilation is performed incrementally to accommodate the retrieval instruments.
• Introducing the Retrieval Introducer The leadless pacemaker retrieval introducer is placed into the vein, and the guidewire is subsequently removed to allow for the next steps.
• Placement of Retrieval Catheter Under fluoroscopy, the retrieval catheter is advanced through the introducer and navigated through the inferior vena cava into the right atrium, where the leadless pacemaker is located.
• Capturing the Pacemaker 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• Withdrawal and Closure Once the pacemaker is captured, the retrieval catheter, along with the pacemaker, is withdrawn from the body. Finally, the access site is closed to complete the procedure.

3. Post-Procedure

After the transcatheter removal of the leadless pacemaker, patients are typically monitored for any immediate complications or adverse effects. Post-procedure care may include observation for signs of bleeding or infection at the access site. Patients may also be advised on activity restrictions and follow-up appointments to ensure proper recovery and to assess the need for any further interventions, such as the implantation of a new device if clinically indicated. It is essential to provide patients with clear instructions regarding signs and symptoms to watch for during their recovery period.