bhargavi
Guru
Procedure(s): BiV PPM PG replacement and Upgrade to BiV ICD
Indications:
PPM RRT
LBBB
Nonischemic dilated cardiomyopathy EF declined to 30-35%; Primary Prevention
Chronic systolic CHF FC III
Hardware Implanted:
## MRI COMPATIBLE SYSTEM ##
Boston Scientific BiV ICD MOMENTUM CRT-D MN
Hardware Explanted:
Guidant BiV PPM
Procedure Details
The risks, benefits, complications, treatment options, and expected outcomes were discussed with the patient. The patient and/or family concurred with the proposed plan, giving informed consent. Patient was marked and timeout done.
The antibiotic was completely infused. The patient was prepped and draped in the usual sterile fashion and the left upper chest anesthetized with 10 cc of 50/50 mixture of 0.25% marcaine and 2% lidocaine. An incision was made in the deltopectoral groove and electrocautery used to perform dissection down to the device pocket where the pocket was incised, device delivered, and the leads tested. The old PG was explanted. The old RA, RV ICD lead and LV leads were secured to the new device and placed into the pocket after irrigation with a NS solution and hemostasis. The pocket was expanded to accommodate the new generator. The old capped shocking electrodes were incorporated into the new system. The new system is now MRI conditional.
DFT testing was deferred.
The incision was closed in 3 layers, the lower two with running 2-0 Vicryl and the cutaneous with 4-0 Vicryl. Steri-Strips and a dry sterile dressing were placed over the wound and the patient was transferred to the PACU in stable condition for recovery from anesthesia.
Measured Data:
P wave 2.3 mV, 559 ohms, thr 0.6 V at 0.4 ms
RV R wave 18.7 mV, 471 ohms, thr 0.7 V at 0.4 ms
LV 1009 ohms, thr 1.3 V at 0.8 mv (Bipolar lead)
Final Parameters:
DDDR 70-130 with single zone for Rx at 185 BPM with ATP then 41 J.
Anesthesia: MAC
Implants
DEFIBRILLATOR CARDIAC MOMENTUM HEARTLOGIC ENDURALIFE SMARTCRT D .99 CM W 5.37 CM X H 8.08 CM 32 CC 72.8 GM RIGHT ATRIUM VENTRICLE LEFT VENTRICLE IS-1 DF-1 CONNECTOR CRT-D - S137793 - LOG600707
Inventory Item: DEFIBRILLATOR CARDIAC MOMENTUM HEARTLOGIC ENDURALIFE SMARTCRT D .99 CM W 5.37 CM X H 8.08 CM 32 CC 72.8 GM RIGHT ATRIUM VENTRICLE LEFT VENTRICLE IS-1 DF-1 CONNECTOR CRT-D Serial no.: 137793 Model/Cat no.: G125
Implant name: DEFIBRILLATOR CARDIAC MOMENTUM HEARTLOGIC ENDURALIFE SMARTCRT D .99 CM W 5.37 CM X H 8.08 CM 32 CC 72.8 GM RIGHT ATRIUM VENTRICLE LEFT VENTRICLE IS-1 DF-1 CONNECTOR CRT-D - S137793 - LOG600707 Laterality: N/A Area:
Manufacturer: Boston Scientific Corp Date of Manufacture:
Action: Implanted Number Used: 1
Device Identifier: Device Identifier Type:
Guidant pacemaker
Inventory Item: Serial no.: H120-117856 Model/Cat no.: H120-117856
Implant name: Guidant pacemaker Laterality: N/A Area:
Manufacturer: Guidant Corp Date of Manufacture:
Action: Explanted Number Used: 1
thanks in advance
i am coming up as 33233, 33249 biv pacemaker explant and biv icd implant - same leads reused so should i do 33264? instead of 33249?
Indications:
PPM RRT
LBBB
Nonischemic dilated cardiomyopathy EF declined to 30-35%; Primary Prevention
Chronic systolic CHF FC III
Hardware Implanted:
## MRI COMPATIBLE SYSTEM ##
Boston Scientific BiV ICD MOMENTUM CRT-D MN
Hardware Explanted:
Guidant BiV PPM
Procedure Details
The risks, benefits, complications, treatment options, and expected outcomes were discussed with the patient. The patient and/or family concurred with the proposed plan, giving informed consent. Patient was marked and timeout done.
The antibiotic was completely infused. The patient was prepped and draped in the usual sterile fashion and the left upper chest anesthetized with 10 cc of 50/50 mixture of 0.25% marcaine and 2% lidocaine. An incision was made in the deltopectoral groove and electrocautery used to perform dissection down to the device pocket where the pocket was incised, device delivered, and the leads tested. The old PG was explanted. The old RA, RV ICD lead and LV leads were secured to the new device and placed into the pocket after irrigation with a NS solution and hemostasis. The pocket was expanded to accommodate the new generator. The old capped shocking electrodes were incorporated into the new system. The new system is now MRI conditional.
DFT testing was deferred.
The incision was closed in 3 layers, the lower two with running 2-0 Vicryl and the cutaneous with 4-0 Vicryl. Steri-Strips and a dry sterile dressing were placed over the wound and the patient was transferred to the PACU in stable condition for recovery from anesthesia.
Measured Data:
P wave 2.3 mV, 559 ohms, thr 0.6 V at 0.4 ms
RV R wave 18.7 mV, 471 ohms, thr 0.7 V at 0.4 ms
LV 1009 ohms, thr 1.3 V at 0.8 mv (Bipolar lead)
Final Parameters:
DDDR 70-130 with single zone for Rx at 185 BPM with ATP then 41 J.
Anesthesia: MAC
Implants
DEFIBRILLATOR CARDIAC MOMENTUM HEARTLOGIC ENDURALIFE SMARTCRT D .99 CM W 5.37 CM X H 8.08 CM 32 CC 72.8 GM RIGHT ATRIUM VENTRICLE LEFT VENTRICLE IS-1 DF-1 CONNECTOR CRT-D - S137793 - LOG600707
Inventory Item: DEFIBRILLATOR CARDIAC MOMENTUM HEARTLOGIC ENDURALIFE SMARTCRT D .99 CM W 5.37 CM X H 8.08 CM 32 CC 72.8 GM RIGHT ATRIUM VENTRICLE LEFT VENTRICLE IS-1 DF-1 CONNECTOR CRT-D Serial no.: 137793 Model/Cat no.: G125
Implant name: DEFIBRILLATOR CARDIAC MOMENTUM HEARTLOGIC ENDURALIFE SMARTCRT D .99 CM W 5.37 CM X H 8.08 CM 32 CC 72.8 GM RIGHT ATRIUM VENTRICLE LEFT VENTRICLE IS-1 DF-1 CONNECTOR CRT-D - S137793 - LOG600707 Laterality: N/A Area:
Manufacturer: Boston Scientific Corp Date of Manufacture:
Action: Implanted Number Used: 1
Device Identifier: Device Identifier Type:
Guidant pacemaker
Inventory Item: Serial no.: H120-117856 Model/Cat no.: H120-117856
Implant name: Guidant pacemaker Laterality: N/A Area:
Manufacturer: Guidant Corp Date of Manufacture:
Action: Explanted Number Used: 1
thanks in advance
i am coming up as 33233, 33249 biv pacemaker explant and biv icd implant - same leads reused so should i do 33264? instead of 33249?