dtruelson
Guest
I'm lost on this one-any help would be greatly appreciated. I'm thinking 93631 for the mapping??? No idea on the ablation.
Indications: Ventricular tachycardia
Procedure Details: Successful EP study and catheter ablation of ventricular tachycardia. Following sternotomy and exposure by Drs Gosev and Wood, the ventricles were mapped with an HD Grid multipolar catheterand the EnSite system. The epicardial surface of both right and left ventricles were mapped in sinus rhythm. This revealed a region of dense scar in the infero-apex extending out to inferolateral apex of the LV. In addition, a region with heterogeneous slow conduction with dense isochronal lines was noted in high anterollateral wall of the LV.
The apex was cored and the endocardium was accessible through this site. Serial cryo-ablationlesions with 3 minute applications each were applied to the endocardial surface in both of these regions by Dr Gosev.
In addition, pre-op nuclear study demonstrated a discrete scar in the anteroseptum which is also consistent with his ECG findings of QS patterns in the early precordial leads indicative of prior anteroseptal MI. Therefore, cryo-ablation was also delivered in the anteroseptum. Despite care of not extending the ablation catheter basally, the patient developed progressive prolongation of PR and complete heart block. The cryo ablation was terminated promptly. Junctional escape was noted in the 30's bpm and decision was made to carry out with more lesions in the septum but even further away from the base. By the end of the procedure, AV conduction resumed.
Findings: Discrete regions of scar noted in the infero-apex, inferolateral apex and high anterolateral wall.
Successful intraop VT ablation.
Complications: Temporary AV block which recovered
Indications: Ventricular tachycardia
Procedure Details: Successful EP study and catheter ablation of ventricular tachycardia. Following sternotomy and exposure by Drs Gosev and Wood, the ventricles were mapped with an HD Grid multipolar catheterand the EnSite system. The epicardial surface of both right and left ventricles were mapped in sinus rhythm. This revealed a region of dense scar in the infero-apex extending out to inferolateral apex of the LV. In addition, a region with heterogeneous slow conduction with dense isochronal lines was noted in high anterollateral wall of the LV.
The apex was cored and the endocardium was accessible through this site. Serial cryo-ablationlesions with 3 minute applications each were applied to the endocardial surface in both of these regions by Dr Gosev.
In addition, pre-op nuclear study demonstrated a discrete scar in the anteroseptum which is also consistent with his ECG findings of QS patterns in the early precordial leads indicative of prior anteroseptal MI. Therefore, cryo-ablation was also delivered in the anteroseptum. Despite care of not extending the ablation catheter basally, the patient developed progressive prolongation of PR and complete heart block. The cryo ablation was terminated promptly. Junctional escape was noted in the 30's bpm and decision was made to carry out with more lesions in the septum but even further away from the base. By the end of the procedure, AV conduction resumed.
Findings: Discrete regions of scar noted in the infero-apex, inferolateral apex and high anterolateral wall.
Successful intraop VT ablation.
Complications: Temporary AV block which recovered