CPT® Code 0802T

1. Indications

The procedure associated with CPT® Code 0802T is indicated for the following conditions:

• Battery Depletion Replacement of the leadless pacemaker is performed when the battery life of the pacemaker component is depleted.

2. Procedure

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

• Step 1: Preparation The groin area is prepped and draped to maintain a sterile environment. Access to the femoral vein is established, which is crucial for the subsequent steps of the procedure.
• Step 2: Accessing the Femoral Vein A guidewire is placed into the femoral vein, and venous ultrasound may be utilized to visualize the anatomy, ensuring accurate access to the vein.
• Step 3: Insertion of Femoral Sheath A femoral sheath is placed into the vein, followed by incremental dilation to accommodate the retrieval introducer.
• Step 4: Placement of Retrieval Introducer The leadless pacemaker retrieval introducer is inserted into the vein, and the guidewire is subsequently removed to allow for the placement of the retrieval catheter.
• Step 5: Catheter Advancement Under fluoroscopic guidance, the retrieval catheter is advanced through the inferior vena cava into the right atrium, where it is positioned to capture the leadless pacemaker using a snare technique.
• Step 6: Retrieval of Pacemaker Once the pacemaker is securely captured, the retrieval catheter, along with the pacemaker, is withdrawn from the body.
• Step 7: Insertion of Replacement Pacemaker A 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 8: Testing the Pacemaker The new pacemaker is tested by sending signals from an external programmer to ensure it is functioning correctly. Mapping is performed to ensure accurate placement.
• Step 9: Deployment of Pacemaker The leadless pacemaker is deployed and positioned securely against the endocardium. It is undocked but remains tethered during initial testing.
• Step 10: Confirmation of Functionality 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 before the tether is released.
• Step 11: Withdrawal of Delivery Catheter The delivery catheter is withdrawn after the tether is released, completing the replacement process for the right atrial component.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any complications and ensuring the proper functioning of the newly implanted pacemaker. Patients may require follow-up evaluations to assess the pacemaker's performance and to confirm that the implantation site is healing appropriately. Additional imaging or device interrogation may be performed to ensure that the pacemaker is operating within the expected parameters.