# Implantation of debrillator/biventrucular pacemaker



## yayasjfp (Jun 17, 2010)

How do I post Implantation of debrillator/biventrucular pacemaker?

The operative notes are as follows:
A cutaneous incision was made along the left deltopectoral groove and an ICD pocket was dessected out, was prepared with extensive dissection.
Thrre separate guidewires were advanced into the left subclavian vein using the Seldinger technique across the open pocket. The middle of these wires was then used to advance a coronary sinus sheath for placement of the left ventricular lead. With some difficulty, were were finally able to advance the coronary sinus sheath in the mid coronary sinus and an angiogram was obtained. A left ventricular lead was then advanced in the lateral cardiac vein and the tip was advanced to the near LV apex. Electrical testing was done at 3 separate locations and the rest of these noted a lead impedance is 840 ohms and an R wave value of 17.1 mV,
Next the bipolar right ventricular defribrillator active fixation lead was advanced to the right ventricle, several areas were checked and the lead was
finally fixated along the RV. 
Next the bipolar right ventricular defibrillator active fixation lead was advanced to the right atrium. Several areas checked and the lead was finally fixated along the RV septum and tested.
Next a bipolar screw in type right atrial lead was advanced to the right atrium and the lead was fixated to the right atrial wall. The coronary sinus sheath was then removed with the cutting device maintaining a good lead position of the LV lead. 
All 3 lead were then sutured to the pectoral fascia over the silastic sleeves. The pocket irrigated. THe leads were then attached to the ICD/BiV device. The ICD was then placed in the pacer pocket after a standard dose of thrombin material in the pocket. Pocket was then sutured close.
The patient was given propofol and the following establishment of adequate general anesthesia. Ventricular fibrillation was induced. THe advice analyzed and delivered 3 separate DC countershocks, at last at 36V and the patient converted back to normal sinus rhythm. Patient was awakened from sedation without obvious side effects.

Yayasjfp


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## twizzle (Jun 17, 2010)

*Imkplntation of bivent ICD*

33249,33225,93641 should do it.
33249 is the ICD system(generator and lead(s)
33225 is the left ventricular lead via coronary sinus
93641(P or 26) is the defib testing.
The MD would also normally use fluoroscopy(71090P/26) to place the leads but it's not documented in this case.


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## twizzle (Jun 17, 2010)

*Implantation*

Don't know where I got that strange word from for the title. Implantation is better.


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## yayasjfp (Jun 21, 2010)

Thanks for the help.


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