Clinical Context
A 62-year-old patient with drug-refractory, symptomatic bradyarrhythmia and documented episodes of syncope is evaluated by a cardiac electrophysiologist. After noninvasive testing and invasive electrophysiology study, the team determines that an implantable, non-rechargeable neurostimulator with transvenous sensing and stimulation leads (C1823) is indicated to provide chronic pacing and sensing therapy via transvenous leads. The typical workflow includes pre-procedure evaluation (history, medication review, informed consent, device and lead selection), perioperative antibiotic prophylaxis, implantation in an electrophysiology lab or hybrid operating room under conscious sedation or monitored anesthesia care, transvenous lead placement via subclavian or cephalic approach, creation of a subcutaneous generator pocket (usually left or right subclavian), intraoperative device interrogation and programming, wound closure, and immediate post-operative device and wound checks. Typical site of service is an ambulatory surgical center or hospital outpatient department; inpatient admission occurs if medical comorbidities require observation or if complications arise. Typical patient scenario modifiers that may apply include AS for anesthesia services, UE for an item furnished by the hospital to its outpatient, and NU for a new device. Postoperative care includes device interrogation at discharge and scheduled follow-up in device clinic for programming and remote monitoring enrollment.