PROCEDURE PERFORMED:
Medtronic pacemaker generator change.
INDICATIONS:
Pacemaker generator at ERI.
The risks and benefits of pacemaker generator change was discussed with
the patient and her daughter. She is agreeable to the procedure. Consent
was obtained.
Time-out was performed. The patient, procedure, and physician were identified.
She received Versed 1 mg, fentanyl 50 mcg intermittently during the procedure
for conscious sedation.
The patient was prepped and draped in the normal fashion. 1% lidocaine
was infiltrated at the left lateral border of the old pacemaker generator.
A 3 to 4 cm linear incision was made. The patient’s skin was very
thin and the pacemaker generator was notably superficial. The pacemaker
leads were also notably visible under the very thin skin. Bovie cauterization
and blunt dissection were carried down to the pacer capsule. The pacer
capsule was notably heavily calcified with an eggshell case. The pacemaker
generator was externalized and a new pacer was attached to the atrial
and ventricular lead. Note, the atrial lead is a nonfunctional lead.
Rather than leaving a blunt and pacer lead that was capped under a
thin skin, it was decided to place the cap in a dual-chamber head in
an effort to reduce risk for site erosion from the lead tip. The heavily
encasement calcification was meticulously removed. Extensive dissection
and debridement of the calcific shell was performed. The atrial and
ventricular lead were mobilized. The leads were tacked down to reduce
the tension that was previously noted before the procedure in an effort
to reduce risk for lead erosion. The new pacer pocket was made a bit
more inferior than the previous pocket. The pacer was secured to the
pectoralis. The pacemaker pocket was generously irrigated with antibiotic
solution. The pacer pocket was closed with 2-0 Vicryl interrupted sutures
for the deep layers. Generous puckering of the skin was noted to reduce
the tension of the very thin superficial placement of the generator.
The subcuticular layer was closed with 4-0 Monocryl. The incision
was covered with benzoin and Steri-Strips.
The patient awoke from conscious sedation without apparent neurologic
deficit. She was transferred to the holding area in stable condition.
The pacemaker generator is a Medtronic Azure XT DR MRI, model #W1DR01,
serial #.
The atrial lead is model #4271 Boston Scientific, serial #, implanted
10/04/1993.
The right ventricular lead is a Boston Scientific model #4262, serial
#, again serial #. R-wave is 9.9, pacing impedance is
380 ohms, pacing threshold is 1.5 at 0.4 milliseconds. The atrial lead
is inactivated. The impedance was noted to be 114 ohms.