# EP/Ablation Help



## dpumford (Sep 3, 2009)

Hello, I am hoping someone can review this report and let me know what they think! 

Using floroscopic guidance axillary vein was cannulated and cornary sinus catheter was advanced into the coronary sinus.  A 7-French introduceer was placed in the rt fem vein adn an 8-mm tip ablation catheter was advanced into the rt atrium.

With rapid pacing from the 7 o'clock positon on the tricuspid valve, artrial flutter was induced (93610-26).  She did have a short episode of typical artrial flutter that was not sustained, it was not clear which tachcardia is the clinical tachycardia,so it was decided to place a line of block at 6 o'clock on the tricuspids valve annulus.  Two lines were mad but we were unable to successful ablate P waves along the inferior aspect of the cavotricuspid isthmus, so we switched cathertes to a ThermoCool cath, these A waves were easly ablated and after the last application of radio entergy bidirectional block was demonstrated.

Prior to placing the line of block, conduction time from the coronary sinus to 7o'clock was 85 millseconds and from 7 o'clock conduction time had increased to 145 miliseconds; in the counterclockwise direction from 7 o'clock to cornary sinus, cond time had increased from 85 millis to 155 miliseconds.  In addition, where atrial flutter had been easily induced prior to procedure, we could no longer induce atreial flutter .

We have a charge sheet that the doctor marks what he does and we reivew but he has me unsure on this one.  He marked 93600-26, 93602-26, 93610-26, & 93618-26 he also said he did  93613-26 but I see no mention of mapping??
and ablation code 93651 which is correct but its the EP part that has me unsure!

Can anyone assist me with this 

Thank you in advance!!!


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