Case Three
Process: Twin Chamber Implantable Cardioverter Defibrillator (ICD) Implantation Pre-Process Prognosis: Hypertrophic Cardiomyopathy, NSVT, SSS, Close to Syncope Process: The affected person was dropped at the Electrophysiology Lab within the fasting state and steady electrocardiographic monitoring was instituted. Anesthesia was carried out by Dr Kiss and will probably be dictated individually by him. The left subclavicular fossa was prepped and draped within the standard sterile style and 1% lidocaine was instilled for native anesthesia. The incision was made and the dissection was carried right down to the extent of the pectoralis main fascia the place a subcutaneous pocket was shaped utilizing blunt dissection. The axillary vein was entered with a Micropuncture skinny walled needle with out problem at two separate places, guided by ultrasound, and information wires had been superior into the central venous circulation. Utilizing the information wires and two introducer sheaths, an ICD electrode was superior to the fitting ventricular septum, and a pacing electrode was superior to the fitting atrial appendage below fluoroscopic steerage. Every electrode was anchored to the underlying pectoralis main fascia with a single sew of 2-Zero non-absorbable suture. These leads had been connected to a twin chamber ICD which was positioned within the beforehand shaped pocket with electrodes located beneath it after the pocket had been flushed with saline answer. The ventricular electrode is a Medtronic Mannequin # 6935M62 (Serial # TDL515430V). This can be a bipolar, steroid-tipped, lively fixation lead. The R wave was 10 mV, the pacing impedance was 600 Ohms, and the ventricular seize threshold was Zero.75 V @ Zero.5 ms. The HVB impedance was 76. There was no diaphragmatic pacing at 10 V. The atrial electrode is a Medtronic Mannequin # 5076 (Serial # PJN8450680). This can be a bipolar, steroid-tipped, lively fixation lead. The P wave was 1.Three mV, the pacing impedance was 650 Ohms, and the atrial seize threshold was 1.Three V @ Zero.5 ms. There was no diaphragmatic pacing at 10 V. The ICD pulse generator is a Medtronic Evera MRI DR. Mannequin # DDMB1D4, Serial # PFZ622773S. This gadget is positioned within the subcutaneous location. No defibrillation threshold testing was carried out. The wound was closed with a working sew of Three-O absorbable suture and the pores and skin was closed with a working sew of Four-O absorbable suture. Topical pores and skin adhesive was positioned over the incision. The affected person tolerated the process effectively.
