Report for His Bundle Pacemaker

1. Your Medical Center Goes Here
XXX Sunshine Road
YourTow n, XX 00000
Department of Cardiology
Operative Report
Patient Name: @name@
Medical Record:
Date of Birth:
Date:
Procedure Performed:
1. Dual-chamber pacemaker insertion w ith transvenous leads under fluoroscopic guidance, w ith ventricular lead in His
bundle position
Indications: {Indication for pacemaker:95547}
Surgeon:
Anesthesia: {Type of anesthesia:36758::"local, supplemented w ith conscious sedation"}
Description of Procedure: The patient presented to the EP Lab in the fasting state. Informed consent w as obtained.
Vancomycin w as given for antibiotic prophylaxis. {{EP ANESTHESIA TEXT:38887::"Midazolam and fentanyl w ere given for
sedation."}
The left chest w as prepped and draped in the usual sterile fashion. Local anesthesia w as obtained w ith 1% lidocaine. A 5
cm incision w as made medial and almost perpendicular to the left deltopectoral groove and carried dow n to the pectoralis
fascia. A pacemaker pocket w as fashioned in the prepectoral plane w ith blunt dissection. We obtained a left upper extremity
venogram by injecting 15 mL of Isovue through a left peripheral venous line. This delineated the course of the left axillary
vein, w hich w as w idely patent. The axillary vein w as accessed w ith 2 punctures from inside the pocket. First access w as
obtained w hile contrast w as flow ing; second one, using the first guidew ire as radioscopic target. Tw o floppy guidew ires
w ere advanced to the IVC. Over the lateral guidew ire, w e used a double guidew ire technique for unrestricted venous
access. Using a preshaped C315 H guiding catheter, a lumenless 4F active- fixation lead (Medtronic 3830-69, SN LFF***)
w as advanced to the right side of the heart under fluoroscopic guidance. The tip of the lead w as used to map the septum for
a His bundle deflection. Once a consistent His deflection w as identified, the lead w as fixated in place. The His bundle
capture threshold w as *** V at 1 ms. This w as nonselective His bundle capture. Ventricular capture w as lost at *** V. The R
w ave measured *** mV. The impedance w as *** oms. The guiding catheter w as cut aw ay, making sure that the lead did not
move and had enough slack. Over the medial guidew ire, w e advanced a 7F peel-aw ay introducer. An active- fixation,
steroid-eluting lead (Medtronic 5076, SN PJN***) w as now advanced to the right side of the heart under fluoroscopic
guidance and positioned in the right atrial appendage. The capture threshold w as *** V at 0.4 ms. The P w ave measured
*** mV. The impedance w as *** ohms. There w as no diaphragmatic stimulation w hen pacing at 10 V. The leads w ere
attached to the pectoralis fascia w ith anchoring sleeves and nonabsorbable sutures. Hemostasis w as obtained. Pursestring
sutures that had been placed around the venous entry sites w ere now tied off. The pocket w as flushed w ith vancomycin
solution. A rate-responsive dual-chamber pacemaker (Medtronic A2DR01, SN PVY***) w as attached to the leads and
implanted in the preformed pocket. There w as a good fit. Appropriate function w as documented by telemetric
measurements.
Correct needle, instrument and sponge counts w ere reported. The edges of the w ound w ere infiltrated w ith 0.5%
bupivacaine. The w ound w as closed in tw o layers w ith absorbable sutures. The skin w as approximated w ith staples. A bulky
dressing w as applied. Estimated blood loss w as *** mL. Fluoroscopy time w as *** minutes. Total amount of Isovue used w as
15 mL.
Final pacemaker programming is {PACING MODES:30274::"DDDR"}.
The patient tolerated the procedure w ell. {EP WESTON DISPOSITION AFTER DEVICE:116465:x}