CPT® Code 0863T

1. Indications

The relocation of the pulse generator for a wireless cardiac stimulator is indicated in specific clinical scenarios where optimization of cardiac pacing is necessary. The following conditions may warrant this procedure:

• Reverse Remodeling This condition occurs when the heart begins to restore its function closer to normal, necessitating adjustments to the pacing system to enhance its effectiveness.
• Inadequate Cardiac Resynchronization Therapy (CRT) When the existing wire lead is not providing sufficient stimulation to the left ventricle, leading to suboptimal therapeutic outcomes.

2. Procedure

The procedure for relocating the pulse generator for a wireless cardiac stimulator involves several critical steps to ensure proper placement and functionality of the device. The following procedural steps are outlined:

• Step 1: Incision An incision is made at the previous implant site where the transmitter component was originally placed. This allows access to the existing pocket where the device is housed.
• Step 2: Opening the Pocket The existing pocket is carefully opened to expose the transmitter component. This step is crucial for accessing the device and making necessary adjustments.
• Step 3: Removal of Sutures The sutures that secure the transmitter in place are removed. This step is essential to allow for the repositioning of the transmitter within the pocket.
• Step 4: Adjusting the Transmitter Position The position of the transmitter is adjusted to optimize its communication with the lead. This adjustment is vital for ensuring effective pacing and overall device performance.
• Step 5: Resecuring the Transmitter Once the transmitter is repositioned, it is resecured in the subcutaneous pocket to maintain its new location and ensure stability.
• Step 6: System Evaluation After the transmitter has been repositioned, the entire system is evaluated for biventricular pacing capture and functionality. This assessment is critical to confirm that the device is operating as intended.
• Step 7: Wound Closure Finally, the incision site is closed, completing the procedure and ensuring that the area is properly healed.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any complications and ensuring that the pacing system is functioning correctly. Patients may be advised to follow specific instructions regarding activity levels and wound care to promote healing. Regular follow-up appointments may be scheduled to assess the performance of the relocated transmitter and to make any necessary adjustments to the pacing settings. It is essential to ensure that the patient is responding well to the therapy and that the device is effectively providing the intended cardiac resynchronization.