PROCEDURE:
AICD generator change.
INDICATIONS:
Generator is at ERI. The patient with history of hypertrophic obstructive
cardiomyopathy, ventricular tachycardia and cardiomyopathy, ejection
fraction less than 30%.
The risks and benefits of pacer/ICD generator change were discussed with
the patient and his wife. They are agreeable to the procedure. Consent
was obtained.
Time-out was performed. The patient, physician, and procedure to be
performed were identified.
The patient was sedated by the Anesthesia Department.
The patient was prepped and draped in the normal fashion. 1% lidocaine
was generously infiltrated into the old pacer pocket incision site.
A linear incision 3 to 4 cm was made directly over the previous scar.
Bovie cauterization and blunt dissection were carried down to the capsule.
The capsule was entered and the pacemaker generator was externalized.
There was difficulty in externalizing the generator due to extensive
scar formation and scarring of the pacer pocket. The leads were removed
and attached to the new pacemaker generator. The pacer was internalized
and secured to the pectoralis muscle. Before insertion of the new generator,
the pocket was irrigated with antibiotic solution copiously. The pocket
was closed with 2 layers of Vicryl 2-0. The subcuticular layer was
closed with 4-0 Monocryl.
The pacemaker generator is a Boston Scientific Dynagen mini ICD IS-1/DF-1
DR, model #D023, serial #250298.
The right atrial lead was implanted 07/16/2009, model #4469, serial #514341.
The right ventricular lead was implanted 07/16/2009. Model #178392.
The right atrial threshold is 4.1 mV, impedance is 374 ohms, 1.2 V
at 0.4 milliseconds.
The right ventricular lead intrinsic is 10.3, impedance is 552, threshold
is 1.9 V at 1.0 milliseconds.
The mode is DDD. ICD VF zone 220, duration 1 second. VT rate 180, duration
2.5 seconds.
The patient awoke from anesthesia without apparent neurologic deficits.
He was transferred to the recovery area in stable condition. Chest
x-ray will be obtained.