What would you code? Thanks
PROCEDURE: Isuprel challenge.
PRE-PROCEDURE DIAGNOSIS: Symptomatic premature ventricular
contractions.
The patient was referred for a potential EP study and ablation should she
have an increased amount of premature ventricular contractions.
DESCRIPTION OF PROCEDURE: The patient was observed on the table with
a
12-lead EKG. She had a few premature ventricular contractions
consistent with a left bundle branch inferior axis with the
transition in lead V3 and no subsequent premature ventricular
contractions. Therefore Isuprel was given up to 10 mcg/minute.
During Isuprel infusion and washout the patient had several different
types of premature ventricular contraction morphology, but none of
these appeared to be clinical.
PLAN: Given the above findings there is no need to continue with the
procedure. The best hope will be pace mapping. However, even this
treatment will yield only a
50% success rate. The clinical premature ventricular contraction
appears on the left side, and therefore the risks of continuing the
procedure probably outweigh the benefits. We decided not to proceed.
CONCLUSION: There were a few isolated premature ventricular
contractions noted before starting the case. Despite the high dose
of Isuprel infusion and with exercise the patient s premature
ventricular contraction burden did not increase. Therefore there did
not appear to be a need to proceed with the procedure. The patient
will be prescribed a trial of Verapamil 120 mg a day.
PROCEDURE: Isuprel challenge.
PRE-PROCEDURE DIAGNOSIS: Symptomatic premature ventricular
contractions.
The patient was referred for a potential EP study and ablation should she
have an increased amount of premature ventricular contractions.
DESCRIPTION OF PROCEDURE: The patient was observed on the table with
a
12-lead EKG. She had a few premature ventricular contractions
consistent with a left bundle branch inferior axis with the
transition in lead V3 and no subsequent premature ventricular
contractions. Therefore Isuprel was given up to 10 mcg/minute.
During Isuprel infusion and washout the patient had several different
types of premature ventricular contraction morphology, but none of
these appeared to be clinical.
PLAN: Given the above findings there is no need to continue with the
procedure. The best hope will be pace mapping. However, even this
treatment will yield only a
50% success rate. The clinical premature ventricular contraction
appears on the left side, and therefore the risks of continuing the
procedure probably outweigh the benefits. We decided not to proceed.
CONCLUSION: There were a few isolated premature ventricular
contractions noted before starting the case. Despite the high dose
of Isuprel infusion and with exercise the patient s premature
ventricular contraction burden did not increase. Therefore there did
not appear to be a need to proceed with the procedure. The patient
will be prescribed a trial of Verapamil 120 mg a day.