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could anyone please help me code this properly :
Dual-Chamber Permanent Pacemaker Implantation
OPERATIVE PROCEDURE:
Implantation of a dual-chamber permanent pacemaker.
INDICATIONS:
This is a 49-year-old male who was admitted following a syncopal episode
resulting in a motor vehicle accident, scalp laceration and documented
complete heart block. He was going in and out of complete heart block and
type 2 second-degree AV block. He was brought in the cath lab for
implantation of a dual-chamber permanent pacemaker. Earlier today he had a
diagnostic heart catheterization to rule out significant angiographic coronary
artery disease as a possible etiology for his high-grade AV block.
DESCRIPTION OF PROCEDURE:
After informed consent was obtained, the patient brought in the cath lab,
prepped in the usual sterile fashion. We had previously discussed with the
nephrologist. She suggested that he is close to his baseline creatinine and
if that is what needs to be done, has to be done. Left subclavian venogram
was performed which showed left subclavian vein is patent. It was used as a
landmark, so we infiltrated left upper chest wall with Xylocaine for local
anesthesia. Versed and fentanyl were used for sedation. A pacemaker pocket
was formed in the left upper chest wall without any difficulty. Blunt
dissection was used. Cautery was used for hemostasis. Once we had a pocket,
then we accessed left subclavian vein under fluoroscopic guidance. Initially,
the 8-French sheath was used and then 2 wires were inserted and then 1 wire
was retained and the other wire was used for right ventricular access and then
a right atrial lead was also positioned. Excellent threshold data was
obtained. We used MRI compatible leads because the patient is only 49 years
old and I did not feel comfortable using a standard pacemaker in such a young
person who may require multiple MRIs during his lifetime. Then, an MRI
compatible generator was inserted, pocket was flushed with antibiotic
solution. The patient had his lead sutured in place with the nonabsorbable
sutures. Pocket was closed in multiple layers and then skin was closed using
staples. No immediate complication was noted. The patient was sent to floor
for recovery. A stat portable chest x-ray was ordered.
PROCEDURE FINDINGS:
Pacemaker uses a Medtronic RVDR01 serial number PTN233804H. Leads used are
Medtronic 5086 MRI-52 cm, serial number LFP200635V. The right atrial lead for
right ventricular lead is a Medtronic 5086 MRI-58 cm, serial number
LFP201127V. Lead data is as follows: For the right atrial lead threshold is
0.8 volt at 1.3 milliamp. Impedance of 642 ohms, P-wave amplitude of 3.9.
For the right ventricular lead the threshold is 1.0 volts at 1.4 milliamp.
Impedance is 833 ohms, R-wave amplitude of 14.4. Pacemaker is programmed with
a DDDR low rate of 50, upper rate of 140. No immediate complication was
noted.
Dual-Chamber Permanent Pacemaker Implantation
OPERATIVE PROCEDURE:
Implantation of a dual-chamber permanent pacemaker.
INDICATIONS:
This is a 49-year-old male who was admitted following a syncopal episode
resulting in a motor vehicle accident, scalp laceration and documented
complete heart block. He was going in and out of complete heart block and
type 2 second-degree AV block. He was brought in the cath lab for
implantation of a dual-chamber permanent pacemaker. Earlier today he had a
diagnostic heart catheterization to rule out significant angiographic coronary
artery disease as a possible etiology for his high-grade AV block.
DESCRIPTION OF PROCEDURE:
After informed consent was obtained, the patient brought in the cath lab,
prepped in the usual sterile fashion. We had previously discussed with the
nephrologist. She suggested that he is close to his baseline creatinine and
if that is what needs to be done, has to be done. Left subclavian venogram
was performed which showed left subclavian vein is patent. It was used as a
landmark, so we infiltrated left upper chest wall with Xylocaine for local
anesthesia. Versed and fentanyl were used for sedation. A pacemaker pocket
was formed in the left upper chest wall without any difficulty. Blunt
dissection was used. Cautery was used for hemostasis. Once we had a pocket,
then we accessed left subclavian vein under fluoroscopic guidance. Initially,
the 8-French sheath was used and then 2 wires were inserted and then 1 wire
was retained and the other wire was used for right ventricular access and then
a right atrial lead was also positioned. Excellent threshold data was
obtained. We used MRI compatible leads because the patient is only 49 years
old and I did not feel comfortable using a standard pacemaker in such a young
person who may require multiple MRIs during his lifetime. Then, an MRI
compatible generator was inserted, pocket was flushed with antibiotic
solution. The patient had his lead sutured in place with the nonabsorbable
sutures. Pocket was closed in multiple layers and then skin was closed using
staples. No immediate complication was noted. The patient was sent to floor
for recovery. A stat portable chest x-ray was ordered.
PROCEDURE FINDINGS:
Pacemaker uses a Medtronic RVDR01 serial number PTN233804H. Leads used are
Medtronic 5086 MRI-52 cm, serial number LFP200635V. The right atrial lead for
right ventricular lead is a Medtronic 5086 MRI-58 cm, serial number
LFP201127V. Lead data is as follows: For the right atrial lead threshold is
0.8 volt at 1.3 milliamp. Impedance of 642 ohms, P-wave amplitude of 3.9.
For the right ventricular lead the threshold is 1.0 volts at 1.4 milliamp.
Impedance is 833 ohms, R-wave amplitude of 14.4. Pacemaker is programmed with
a DDDR low rate of 50, upper rate of 140. No immediate complication was
noted.