GEN CHANGE SC-PPM

EP PROCEDURE NOTE

DATE OF PROCEDURE: 

PRE-OPERATIVE DIAGNOSIS:
1. Pulse Generator Battery depletion.

POSTOPERATIVE DIAGNOSIS:
1.  Successful ____ Generator Change.

PROCEDURE PERFORMED:
1.  ____ Pacemaker Pulse generator change.
2.  Removal (explantation) of chronic generator. 

ELECTROPHYSIOLOGIST:  Michael Bui, MD 

ASSISTANT: 

CLINICAL PROFILE:

COMPLICATIONS: None. 

ESTIMATED BLOOD LOSS: Less than 20 cc. 

FLUORO TIME:  min
DAP:  Gycm2
AIR KERMA: mGy

PROCEDURE: 
The risks and benefits of the procedure were explained to the patient in
full, and in simple terms.  Alternative therapy options were given,
including no procedure.  The risks of the procedure include, but are not
limited to: pain, bleeding, infection, pneumothorax, perforation of
vessels or heart, pericardial effusion, lead dislodgement, and death. The
risks of blood transfusion were discussed, and include fever, transfusion
reaction, and infection. All questions were answered, and the patient
voices understanding. The patient acknowledged the risks of the procedure,
and still wanted to proceed.   

*************************
The chronic device was interrogated prior to the procedure, and pertinent
information, such as underlying rhythm, programming, thresholds and
impedances were noted.  Of note, the patient

      is pacemaker dependent.

      is non-pacemaker dependent.

*******************************************

The patient was brought into the Electrophysiology Lab in a fasting and
hemodynamically stable condition. 

A formal time out for patient identification and review of procedure was
performed.  The left chest wall was vigorously washed, prepped, and
sterilely draped. The chest wall was anesthetized with lidocaine.  

An approximately 4-cm incision was made over the old incision line.
Electrocaudery was used to access the pocket, with adequate hemostasis
being provided throughout. After reaching the capsule, the previous suture
material was ligated and removed from the pocket. The pulse generator was
then easily removed. The wrench tool was used to detach the lead from the
pulse generator. The pocket was then vigorously washed with an antibiotic
containing solution. The new device generator was then obtained and the
previous chronic lead was then securely attached to the pulse generator
using a wrench tool.  The lead was then analyzed via the programmer, and
sensing thresholds, pacing thresholds, and impedences were all stable. 

************
The pulse generator was then placed into a Ty-RX antimicrobial envelope,
and then placed into the pocket.  

The pulse generator was then placed in the pocket.  

**********************************

The pocket was closed in 3 layers using 2-0 Vicryl for the deep layers and 4-0
Vicryl for the subcuticular layer. After the procedure, Steri-Strips were
applied to the wound.   The device was then re-interrogated to ensure proper
programming, as well as to check on the impedances and thresholds.  The patient
was then transported back to a monitored bed.

EQUIPMENT USED:
1.  The New Pulse Generator is a _,  serial #
2.  The explanted Pulse Generator is a
3.  The RV Lead is a _, serial #
           
                                                 
MEASUREMENTS THROUGH THE DEVICE:
1.  The RV Lead is sensing R waves of _mV, and has a pacing capture threshold
    of _V @ _msec, giving a pacing impedance of _ohms.

FINAL PROGRAMMING:
Brady Settings:
    -Mode:
    -LRL = 60 ppm.
    -URL = 130 ppm.
    -Paced AV Delay = ____ msec.
    -Sensed AV Delay = _____ msec.  

PLAN:
1.  Wound Care
2.  ECG
3.  Keflex 500 mg po BID x 5 days 
4.  Follow up with Pacemaker Clinic in 2-4 weeks

5.  In its current configuration, this system is MRI compatible with both
    3.0 T and 1.5 T machines