perkins05
Expert
PREOPERATIVE DIAGNOSIS:
Malfunctioning automatic implantable cardiac defibrillator system,
end-of-life indicators and generator.
POSTOPERATIVE DIAGNOSIS:
Malfunctioning automatic implantable cardiac defibrillator system,
end-of-life indicators and generator.
OPERATIVE PROCEDURE:
Replacement of automatic implantable cardiac defibrillator
generator, replacement of right ventricular sensing lead.
DESCRIPTION OF PROCEDURE:
After the placement of adequate intravenous access and arterial
line, general anesthesia was induced. Routine sterile prep and
drape was conducted over the left chest. The skin incision over the
old AICD generator was sharply incised. Soft tissue was dissected
with the use of the electrocautery. There was an abundant amount of
subcutaneous tissue. The device was then a submuscular pocket. It
was dissected from surrounding tissue with care taken to avoid any
damage to the leads. The device was delivered and detached from the
leads. The problem with the system was artifactual sensing in the
RV lead. The patient was being shocked through 2 epicardial patches
which had been placed via a subxiphoid approach several years ago.
Subclavian venous puncture was performed via a separate stab wound.
Under fluoroscopic control a guidewire was passed and then an
appropriately sized tearaway sheath. It was necessary to dilate the
subcutaneous tissue progressively under fluoroscopic control to
allow passage of the sheath. Through the sheath was now advanced a
new right ventricular lead. This was a Biotronik lead. It was
manipulated under fluoroscopic position to an appropriate site in
the right ventricle and electrical parameters were tested. The lead
was secured at the level of the subclavicular incision and tunneled
to the previously created pocket. A new generator which was a
Biotronik Lumax 450 VR-T was brought to the field. Appropriate
electrical connections were made. The device was placed in the
previously created pocket, activated and programmed. Defibrillation
threshold testing was performed. Initially the device failed to
rescue with shock up to 40 watt seconds. The shocking configuration
was reprogrammed with a biphasic shock given in a reversed manner
from previous attempts and this time the device appropriately
identified and terminated induced ventricular fibrillation with a
single shock of 30 watts seconds. The device was now temporarily
deactivated as the wound was closed in layers using absorbable
sutures and skin staples. At the end of the procedure, the device
was activated and programmed. The patient awakened, extubated and
transported to recovery room in stable condition.
codes
33249
33241
33244
Malfunctioning automatic implantable cardiac defibrillator system,
end-of-life indicators and generator.
POSTOPERATIVE DIAGNOSIS:
Malfunctioning automatic implantable cardiac defibrillator system,
end-of-life indicators and generator.
OPERATIVE PROCEDURE:
Replacement of automatic implantable cardiac defibrillator
generator, replacement of right ventricular sensing lead.
DESCRIPTION OF PROCEDURE:
After the placement of adequate intravenous access and arterial
line, general anesthesia was induced. Routine sterile prep and
drape was conducted over the left chest. The skin incision over the
old AICD generator was sharply incised. Soft tissue was dissected
with the use of the electrocautery. There was an abundant amount of
subcutaneous tissue. The device was then a submuscular pocket. It
was dissected from surrounding tissue with care taken to avoid any
damage to the leads. The device was delivered and detached from the
leads. The problem with the system was artifactual sensing in the
RV lead. The patient was being shocked through 2 epicardial patches
which had been placed via a subxiphoid approach several years ago.
Subclavian venous puncture was performed via a separate stab wound.
Under fluoroscopic control a guidewire was passed and then an
appropriately sized tearaway sheath. It was necessary to dilate the
subcutaneous tissue progressively under fluoroscopic control to
allow passage of the sheath. Through the sheath was now advanced a
new right ventricular lead. This was a Biotronik lead. It was
manipulated under fluoroscopic position to an appropriate site in
the right ventricle and electrical parameters were tested. The lead
was secured at the level of the subclavicular incision and tunneled
to the previously created pocket. A new generator which was a
Biotronik Lumax 450 VR-T was brought to the field. Appropriate
electrical connections were made. The device was placed in the
previously created pocket, activated and programmed. Defibrillation
threshold testing was performed. Initially the device failed to
rescue with shock up to 40 watt seconds. The shocking configuration
was reprogrammed with a biphasic shock given in a reversed manner
from previous attempts and this time the device appropriately
identified and terminated induced ventricular fibrillation with a
single shock of 30 watts seconds. The device was now temporarily
deactivated as the wound was closed in layers using absorbable
sutures and skin staples. At the end of the procedure, the device
was activated and programmed. The patient awakened, extubated and
transported to recovery room in stable condition.
codes
33249
33241
33244
