bennieyoung
Guru
Last day of my audit! My auditor thinks that instead of using the diagnosis code I48.92 that I should use I48.3 instead. Do I have an argument?
PreProcedure Dx: Symptomatic Atrial Flutter
PostProcedure Dx: Symptomatic Atrial Flutter
Procedures:
Ultrasound guided femoral vein access
SVT ablation
Clinic Hx: Symptomatic atrial flutter
Procedure:
A time out was performed.
General anesthesia per anesthesia staff
Right Femoral vein access was obtained using ultrasound guidance. The below mentioned sheaths were placed for introduction of catheters.
The ablation catheter was used to obtain 3 dimensional mapping of the right atrium.
The patient was in ongoing atrial flutter. Tachycardia cycle length was 250 milliseconds.There was a proximal to distal activation sequence on the coronary sinus.
Activation mapping in the right atrium revealed greater than 90% of the tachycardia cycle length. The map suggested typical counter-clockwise cavotricuspid isthmus dependent atrial flutter.
Atrial overdrive pacing was performed on the cavotricuspid isthmus resulting in concealed entrainment.
Ablation on the cavotricuspid isthmus was started near the tricuspid annular end. Ablation was performed a point by point fashion back towards the inferior vena cava. Atrial flutter terminated as the ablation line was being completed. Once the ablation line was complete differential atrial pacing was performed which did indeed confirm bidirectional block across the CTI.
Atrial and ventricular programmed stimulation as noted below was performed as well
The catheters and sheaths were removed and the femoral vein access sites were closed with Perclose x3
Hemostasis was achieved.
Catheter Sheath
RFV ST SF FJ ablation catheter Ramp sheath
RFV Decapolar 8F
Procedure data:
Power: 40w
Number of ablations: 59
Ablation time: 643s
Fluoro Time: 6.6 min
Intervals:
Rythm CL PR QRS QT AH HV
Baseline AFl - - 150 332 - 55
Post Procedure NSR 1004 146 152 550 92 50
Left atrial and ventricular pacing and recording were performed (no sustained atrial arrhythmias could be induced):
AVBCL:380
AERP:-
AVNERP:500,340
VERP:600,440
VABCL-
Fluids
1000 cc
EBL
10cc
Complications
Conclusion:
-Successful ablation of typical cavotricuspid isthmus dependent atrial flutter
-Normal peri procedure DCPPM check
Recommendations:
-Continue eliquis
-Monitor on tele floor overnight
PreProcedure Dx: Symptomatic Atrial Flutter
PostProcedure Dx: Symptomatic Atrial Flutter
Procedures:
Ultrasound guided femoral vein access
SVT ablation
Clinic Hx: Symptomatic atrial flutter
Procedure:
A time out was performed.
General anesthesia per anesthesia staff
Right Femoral vein access was obtained using ultrasound guidance. The below mentioned sheaths were placed for introduction of catheters.
The ablation catheter was used to obtain 3 dimensional mapping of the right atrium.
The patient was in ongoing atrial flutter. Tachycardia cycle length was 250 milliseconds.There was a proximal to distal activation sequence on the coronary sinus.
Activation mapping in the right atrium revealed greater than 90% of the tachycardia cycle length. The map suggested typical counter-clockwise cavotricuspid isthmus dependent atrial flutter.
Atrial overdrive pacing was performed on the cavotricuspid isthmus resulting in concealed entrainment.
Ablation on the cavotricuspid isthmus was started near the tricuspid annular end. Ablation was performed a point by point fashion back towards the inferior vena cava. Atrial flutter terminated as the ablation line was being completed. Once the ablation line was complete differential atrial pacing was performed which did indeed confirm bidirectional block across the CTI.
Atrial and ventricular programmed stimulation as noted below was performed as well
The catheters and sheaths were removed and the femoral vein access sites were closed with Perclose x3
Hemostasis was achieved.
Catheter Sheath
RFV ST SF FJ ablation catheter Ramp sheath
RFV Decapolar 8F
Procedure data:
Power: 40w
Number of ablations: 59
Ablation time: 643s
Fluoro Time: 6.6 min
Intervals:
Rythm CL PR QRS QT AH HV
Baseline AFl - - 150 332 - 55
Post Procedure NSR 1004 146 152 550 92 50
Left atrial and ventricular pacing and recording were performed (no sustained atrial arrhythmias could be induced):
AVBCL:380
AERP:-
AVNERP:500,340
VERP:600,440
VABCL-
Fluids
1000 cc
EBL
10cc
Complications
Conclusion:
-Successful ablation of typical cavotricuspid isthmus dependent atrial flutter
-Normal peri procedure DCPPM check
Recommendations:
-Continue eliquis
-Monitor on tele floor overnight