Aicd with repair of lead scenario


San Gabriel Valley,CA
Best answers
IS THIS CORRECT: 33218,33223,93641??? THANK YOU!!!

INDICATIONS: The patient is a very pleasant male with history of paroxysmal
atrial fibrillation, status post multiple direct-current cardioversions because
of proarrhythmia from LV lead. Subsequently, patient went into sinus rhythm
and has been chronically in sinus rhythm. He is here for a new right atrial
lead placement.
Methods, risks and benefits were explained to the patient including the risks
of death, Ml, stroke, bleeding, infection, which is less than 1%.

PROCEDURE: Patient was taken to the EP lab in a fasting state and prepped in
the usual sterile fashion. One-percent Xylocaine was applied to the left chest
wall, thus causing local sedation. A combination of blunt and sharp dissection
created and opened up the AICD pocket.
Thereafter, the pocket capsule was removed. The pocket was expanded. A
venogram of the left subclavian vein was made twice. After the venogram, we
were able to cannulate the left subclavian vein and an 8-French sheath was
placed. A combination of curved and straight stylets was used to place the
right atrial lead in the right atrial appendage. Appropriate thresholds and
impedances were found. High-output voltage did not stimulate the diaphragm.
The lead was sutured down to the chest wall.
The device was placed into the pocket and the lead was placed into the new
port. The pocket was flushed with antibiotic solution copiously. The device
was sutured down to the chest wall. Running 2-0 and 4-0 Monocryl were used to
close the AICD pocket. Dermabond was placed superficially.
The patient tolerated the procedure uneventfully. There were no complications.


The patient has new right atrial lead. Patient has chronic generator. Patient has old chronic RV lead. Patient has chronic LV lead which is off.

Lead measurements: R wave is paced, P wave 2.4 mV, impedance 453, threshold 1
Vat 0.5 ms.