# overdrive pacing/pacemaker



## schmsuz (Jun 17, 2014)

Is overdrive pacing bundled with a dual chamber pacemaker insertion or can it be billed separately?



PROCEDURES: 
Implantation of permanent dual-chamber pacemaker system, Medtronic. 
Overdrive atrial pacing of persistent symptomatic atrial flutter. 


INDICATIONS: A 71-year-old white male with a history of hypertension and COPD who is experiencing persistent well-documented right atrial flutter. He also has significant bradycardia. He, therefore, undergoes dual-chamber pacemaker implantation today to treat the well documented symptomatic bradycardia, and also atrial overdrive pacing will be performed at the same setting to restore sinus rhythm. The patient has been treated with adequate Coumadin therapy for the past 3 weeks. 


DESCRIPTION OF PROCEDURE: Informed consent was obtained. The patient was brought to the cardiac cath lab in a fasting state. The right pectoral region was then prepped and draped in the usual sterile fashion. Xylocaine 1% was used for local anesthetic. The right subclavian vein was then accessed to allow for the insertion of 2 retaining J guidewires after the vein was visualized by peripheral contrast injection. A transverse incision was then made and blunt dissection was performed to create a pacemaker pocket. Under fluoroscopic guidance, the leads were then introduced and were maneuvered into the respective chamber. The ventricular lead was Medtronic model #5076, serial #PJN3318827. It was maneuvered to the right ventricle and actively fixated into the apical region. The R wave amplitude was about 6 mV with ventricular pacing threshold of 0.4 V at 0.5 ms pulse width with the impedance of 590 ohms. The lead was then secured to the fascia using 2-0 silk suture. The atrial lead was then introduced. It was Medtronic model #5076, serial #PJN3236957. It was maneuvered into the right atrium and actively fixated into the appendage area. The patient was in persistent atrial flutter at the time of the study. Overdrive pacing of the atrial flutter was then performed. The patient subsequently induced to atrial fibrillation, and then he subsequently converted spontaneously to normal sinus rhythm. The P wave amplitude was about 3.3 mV with a atrial pacing threshold of 0.5 V at 0.4 ms pulse width with the impedance of 846 ohms. The lead was then secured to the fascia using 2-0 silk suture. The pacemaker pockets were then flushed with antibiotic solution and was inspected, it was cleaned and dried. The leads were then connected to the pacemaker generator, Medtronic model #RVDR01, serial #PTN254069H. The system was then placed into the pacemaker pocket and the generator was then secured to the fascia using 2-0 silk suture. Closure was then performed. The subcutaneous fat layer was closed with 4-0 Vicryl suture and the wound was then sealed with Dermabond. The sponge and needle count were correct. The patient tolerated the procedure well and there were no complications. A portable chest x-ray was obtained and was pending at the time of dictation.


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