Hospital-Based Invasive/Interventional Services

Diagnostic Cardiac Catheterization:

Can include: right and/or left heart catheterization, coronary arteriography, left ventriculography, ascending aortography, specific arterial vascular arteriography [coronary bypass grafts], ileofemoral angiography [particularly as an adjunct for femoral artery vascular closure], selective infusion of therapeutic medications, diagnostic intravascular ultrasound, Doppler coronary flow velocity determination, deployment of a vascular closure device, measurement of right and left heart pressure, and determination of cardiac output (by thermodilution and/or Fick method). Routine vascular access methods include: femoral (Judkins), brachial (Sones), and radial (wrist).

Percutaneous Coronary Intervention (PCI):

Can include: percutaneous transluminal coronary angioplasty (“balloon-angioplasty”), cutting-balloon angioplasty (plaque scoring), endovascular coronary stent deployment, rotational atherectomy (rotational ablation), coronary atherectomy, excimer-laser coronary angioplasty, thrombectomy, foreign body retrieval, and aortic counterpulsation, placement of a mechanical ventricular assistance catheter, and cardiopulmonary support.

Peripheral Arterial Vascular Angiography and Intervention:

Can include: diagnostic arteriography [by selective injection or contrast runoff] of the abdominal vessels (descending aorta, renal, celiac, superior mesenteric, inferior mesenteric arteries or corresponding veins), the lower extremity vessels (iliac, femoral, popliteal, and tibial, and peroneal arteries, the upper extremity vessels (subclavian, axillary, and/or brachial arteries), the cervical (carotid and/or vertebral arteries), and the cerebral vessels. Catheter-based devices available for peripheral vascular intervention are similar to (but not limited to) many of the devices listed above, for coronary intervention.

Pacemaker/Cardioverter-Defibrillator (ICD) Implantation:

Implantation of a single or dual-chamber permanent (or temporary) electronic pacemakers, insertion bi-ventricular pacemaker systems (single or dual chamber options), implantation of a single or dual-chamber implantable cardiac defibrillators (ICDs); and bi-ventricular ICD implantation devices (single or dual chamber). A single chamber device indicates that it is connected to a single lead (electrode), with pacing and sensing capability into a single cardiac chamber (usually the right atrium or the right ventricle). A dual chamber device has 2 separate leads, with one placed into the right atrium, and the other positioned in the right ventricle. A bi-ventricular system is similar to the single or dual chamber systems (described above), but has an additional left ventricular pacing lead positioned in a venous branch (of the coronary sinus) that courses along the left ventricular surface, and allows for left ventricular epicardial pacing simultaneously with right ventricular pacing. All currently available defibrillators have the capability of providing pacemaker function (in addition to their ability to give cardioversion or defibrillatory shocks to attempt to terminate a detected rapid rhythm abnormality). All of the listed devices lie within the vascular spaces (blood vessels and cardiac chambers). The electronic device portion (generator) is usually positioned in a created cleft between a muscular layer and below the subcutaneous fat layer on the chest wall. Newer systems include a “leadless” pacing system, which resides completely within the right ventricular chamber, and a subcutaneous ICD system, which resides entirely in the subcutaneous tissue.

Loop Recorder Insertion:

Surgical insertion of an implantable loop recorder (for long-term detailed arrhythmia monitoring). The loop recorder is self-contained, and does not require a connection to separate implanted electrodes. The device is generally also positioned in the subcutaneous tissue.