heart123
Guest
The patient is a 78-year-old female with known
history of paroxysmal atrial fibrillation and also sick sinus syndrome, status
post pacemaker placement. She was deemed not a good candidate for long-term
anticoagulation therapy due to history of GI bleeding and she now presents
electively for planned left atrial appendage closure procedure.
PROCEDURE IN DETAIL: Prior to procedure, risks and benefits were explained
thoroughly to the patient who consented to the procedure. The patient was
sedated with general anesthesia via the anesthesia service. Of note, a left
radial arterial sheath was placed by the anesthesia service. Arterial blood
pressure was monitored throughout the procedure. Her bilateral groins were
prepped and draped sterilely. Preprocedure antibiotics were given. Using
ultrasound guidance, right femoral venous access was obtained x2. Over a wire,
two separate 8-French sheaths were placed. After establishment of IV access,
subsequently an 8-French intracardiac echo catheter placed at the level of the
right atrium. Of note, the patient with a history of paroxysmal atrial
fibrillation; however, at the initiation of the procedure, she was in atrial
fibrillation with rapid ventricular rate with heart rates in the 110s. As a
result, we decided to proceed with cardioversion. The patient then underwent a
synchronized cardioversion at 200 joules with successful cardioversion to normal
sinus rhythm. Following cardioversion subsequently, transseptal puncture was
then performed. Subsequently, the 8-French sheath in the right femoral vein was
then exchanged over a long wire for Preface transseptal sheath, which was placed
at the level of the superior vena cava. The Baylis RF transseptal needle was
subsequently advanced through the Preface sheath. Heparin bolus was given prior
to transseptal puncture and maintained throughout the procedure to maintain ACT
time of approximately 250 to 300. Subsequently, transseptal puncture was then
performed from the right atrium to the left atrium through the fossa ovalis
using a combination of fluoroscopic as well as intracardiac echo landmarks.
Pressure tracings following transseptal puncture were consistent with left
93462
93662
92960
76937
33340
what am i missing please
history of paroxysmal atrial fibrillation and also sick sinus syndrome, status
post pacemaker placement. She was deemed not a good candidate for long-term
anticoagulation therapy due to history of GI bleeding and she now presents
electively for planned left atrial appendage closure procedure.
PROCEDURE IN DETAIL: Prior to procedure, risks and benefits were explained
thoroughly to the patient who consented to the procedure. The patient was
sedated with general anesthesia via the anesthesia service. Of note, a left
radial arterial sheath was placed by the anesthesia service. Arterial blood
pressure was monitored throughout the procedure. Her bilateral groins were
prepped and draped sterilely. Preprocedure antibiotics were given. Using
ultrasound guidance, right femoral venous access was obtained x2. Over a wire,
two separate 8-French sheaths were placed. After establishment of IV access,
subsequently an 8-French intracardiac echo catheter placed at the level of the
right atrium. Of note, the patient with a history of paroxysmal atrial
fibrillation; however, at the initiation of the procedure, she was in atrial
fibrillation with rapid ventricular rate with heart rates in the 110s. As a
result, we decided to proceed with cardioversion. The patient then underwent a
synchronized cardioversion at 200 joules with successful cardioversion to normal
sinus rhythm. Following cardioversion subsequently, transseptal puncture was
then performed. Subsequently, the 8-French sheath in the right femoral vein was
then exchanged over a long wire for Preface transseptal sheath, which was placed
at the level of the superior vena cava. The Baylis RF transseptal needle was
subsequently advanced through the Preface sheath. Heparin bolus was given prior
to transseptal puncture and maintained throughout the procedure to maintain ACT
time of approximately 250 to 300. Subsequently, transseptal puncture was then
performed from the right atrium to the left atrium through the fossa ovalis
using a combination of fluoroscopic as well as intracardiac echo landmarks.
Pressure tracings following transseptal puncture were consistent with left
93462
93662
92960
76937
33340
what am i missing please