Aborted A-fib Ablation

mcauffman86

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Saint Joseph, MI
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I am new to the EP coding space and am unsure of how the following case should be coded or if there is anything to code at all. Any advice would be greatly appreciated!


Preprocedure diagnosis: persistent atrial fibrillation

Post procedure diagnosis: Persistent atrial fibrillation

Indication: Symptomatic atrial fibrillation refractory to drug therapy

Immediate complications: none

Procedure performed:
1) Aborted af ablation secondary to subtherapeutic ACT related to iv line malfunction.
2) Carto 3-D mapping
3) Intra-cardiac ECHO
4) transseptal puncture
5) Ultrasound guided venous access

DESCRIPTION OF PROCEDURE:

It was my pleasure to see ********* here for the first time at the EP lab. As you recall, ********* is a 71 year old female with a history of persistent atrial fibrillation refractory to drug therapy. This includes Of amiodarone.

Risks and benefits of the procedure were discussed in great detail both in clinic and prior to the procedure. Risks described included that of bleeding, infection, cardiac tamponade, stroke, vascular injury requiring surgery, phrenic nerve paresis, atrial esophageal fistula, as well as death just to name a few. Despite this, the patient was motivated to proceed.

Patient arrived to the EP laboratory in the standard postabsorptive, nonsedated state. Gen. anesthesia was used for the procedure with endotracheal intubation being performed. Following adequate sedation, the patient was prepped and draped in the usual manner. Right and left femoral venous access was obtained using the modified Seldinger technique.


Heparin was then givenafter obtaining access. Subsequently, a double transseptal puncture was performed using both a Preface and Agilis sheath under the guidance of intracardiac echo with A BRK-1 needle. Carto sound was used along with fast activation mapping to re-create both left and right atrial 3-dimensional geometry while obtaining endocardial voltage.

Of note, the patient arrived in afib to the Lab. Catheters selective for the procedure included A Biosense Webster ST–SF Navi-Star catheter along with a Penta ray and coronary sinus catheter.

A Circa catheter was used to monitor esophageal temperature during the ablation procedure.

Once across in the left atrium we checked an ACT which was around 190 seconds. This was clearly subtherapeutic and additional heparin was given. After the second ACT came back subtherapeutic which even less than the first, we began to troubleshoot as to why the act was so low. ACT machines were changed. Different lots of heparin were sought out. We even tried to administer heparin through different iv ports. After about 30 minutes of failing to detect the etiology with repeated low ACTs, I removed the catheters from the left atrium. Perhaps another 15 minutes later after having "administered" 54 thousand units of heparin, the etiology was discovered. This was secondary to a nonfuctioning iv line. Given the 30 minutes of being in the left atrium with a subtherapeutic ACT, I elected to abort the case not knowing whether any thrombus has developed and embolized without the likelihood of having tpa available given anticoagulation with heparin and potentially long drawn out procedure
 
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