Admitted with
EF
*Dual chamber pacemaker
*Single chamber (VR) pacemaker
*Primary prevention ICD (*dual-chamber *single-chamber)
*Secondary prevention ICD
*Primary prevention CRT-D
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Intravenous antibiotics were given pre-procedure.
*I dissected down to the cephalic vein and used it for venous access.
*I located the axillary vein with radiographic guidance and used it for venous access.
Active right atrial appendage and active *single coil right ventricular apical leads placed with good parameters
Dual chamber (DR) *pacemaker placed in pre-pectoral pocket
The wound was closed with absorbable sutures subcutaneously and to the skin.
Set up DDD bpm
AVDs 150/200
*Standard primary prevention ICD settings: *Monitor 160, VT zone 187, 35 intervals, ATP x3 then shocks, VF zone 240 ATP then shocks
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To minimize risk of lead displacement the patient has been advised to minimise movement of the relevant arm for two days and to avoid raising the arm above the horizontal for 4 weeks.
A PA and lateral chest X-Ray is to be performed in *3-4 hours *tomorrow morning to exclude pneumothorax or lead displacement. Please bleep me on 6911 to check the result. If x-ray done out of hours please bleep cardiology registrar on 4205 to check the X-ray.
A pacing check will be performed tomorrow morning *magnet check will be performed later today
May not drive for at least one week *month. Follow up has been arranged in pacemaker *ICD clinic in 6-10 weeks
Suitable for nurse-led discharge
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OC135/AL2/Terumo to CS. Venogram:
Quartet to branch over Courier medium wire
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Incision along old scar
Pocket disrupted and expanded
Device replaced
Wound closed with absorbable sutures
Suitable for nurse-led discharge
No checks needed
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ILR to left parasternal position
Wound closed with absorbable sutures
Suitable for nurse-led discharge
No checks needed