Hi All, Appreciate your help in coding this. I am new to pacemaker coding. TIA.
The patient was prepped and draped in the usual fashion. An loban was used. After a timeout, the skin was infiltrated over 2 marked areas where the intent had been to remove the Reveal and also implant the pacemaker. The Reveal monitor was removed first by incising over the existing scar through a combination of sharp and blunt dissection, removing the generator from under the skin. This pocket was irrigated and approximated with 3-0 Vicryl and a subcuticular layer of 4-0 Monocryl. The patient was then prepped for a cephalic vein cutdown. The skin was infiltrated with Carbocaine over the deltopectoral groove and a cephalic vein cutdown performed.
No cephalic vein was isolated and a subclavian puncture was done using 2 safe sheaths to access thje central circulation. Through this, a 000model ventricular lead was advanced to the right ventricular apex where R-waves measured…threshold was 0.6 volts and impedance was 1050ohms. The lead was fixed to the subcutaneous facia using Ethibond. Through the second safe sheath, an atrial lead which was a 000model lead was advanced to the high rate atrium. The atrial appendage was entered using a preformed guidewire. When acceptable parameters were found, the lead was screwed into position. Both leads were confirmed in their respective positions by RAO and LAO fluoroscopy. The lead was fixed. Additional slack was added to both leads because of tortuosity in the venous system. …..the pocket was closed with two layers of suture…the patient tolerated the procedure well.