0225 - Seq. 9001 (Intra/Post-Procedure Events) Device Embolization-0225 - Seq. 9001 (Intra/Post-Procedure Events) Device Embolization

Video Transcription

Thank you for joining us. The February 2025 case scenario will review device embolization as part of Sequence 9001 intra-post procedure events.  An 87-year-old male is admitted for shortness of breath and persistent weakness associated with dizziness.  They've had a history of MI on December 20, 2023 and a stent placed to their proximal RCA. The initial ECG reveals a heart rate of 41 with a first-degree heart block.  The current left ventricular ejection fraction is 45%. Throughout the evening and overnight, the telemetry monitor reveals episodes of severe bradycardia.  The electrophysiologist is consulted and the shared decision was reached to place a leadless single-chamber pacemaker. Overnight is uneventful.  The device interrogation reveals pacemaker spikes were no longer noted, however, followed by chest X-ray confirming device dislodgement.  The device extraction is performed on the same day with a double snare from the right pulmonary artery.  Our first question, is the device embolization captured for the first or second lab visit? Number one, the first lab visit, or number two, the second lab visit?  Please take a moment to review the documentation before making your final determination. And the answer is number one, first lab visit.  The device embolization event intends to capture if there is documentation that the patient experienced device embolization,  the full dislodgement of a device from its original position that is then introduced to the circulatory system, potentially occluding blood supply to vessels and or organs.  Leadless pacemaker dislodgement may occur usually within 24 hours of implantation. Late occurrences are rare and retrieval experience is limited.  Our follow-up question number two, how is the second lab visit captured? Would an episode of care be added, number one, or an additional lab visit be added, number two?  Please take a moment to review the documentation before making your final selection.  And the answer is number two. To add the additional lab visit within the episode of care, select the correct episode of care,  and under the lab visit left navigation bar, click the add lab visit from the right top corner. Thank you for viewing the EP device implant registries February 2025 case scenario.

Video Summary

The case scenario reviews a device embolization event involving an 87-year-old male with severe bradycardia and a first-degree heart block who had a leadless pacemaker implanted. Overnight, the device became dislodged, confirmed by a chest X-ray, and was extracted. Key questions addressed include recording the device embolization in the first lab visit and how to capture the second lab visit, advising the addition of an extra lab visit in the episode of care. This scenario emphasizes the potential of pacemaker dislodgement within 24 hours and the process for documenting such incidents.

Keywords

EP device implant registry

percutaneous coronary intervention

coronary artery bypass graft

abstraction error

shared decision-making

device embolization

leadless pacemaker

bradycardia

pacemaker dislodgement

documentation process