The EP Device Implant Registry case scenario for March of 2022 will review sequence number 14739, His Left Bundle Lead. A 79-year-old male presents for a scheduled dual-chamber permanent pacemaker. Physician post-procedure note states, the left axillary vein was cannulated by a modified Seldinger technique under ultrasound and fluoroscopic visualization with insertion of a short J-guide wire. An eight French peel-away sheath was placed over the short J-guide wire, through which a long His sheath was placed in the RV and positioned into the septum. His deflection noted, the lead was actively fixated, the lead dislodged, it was repositioned in the septum. The pacing and sensing thresholds were tested and found to be acceptable. The patient is transferred to the recovery unit and discharged home once cleared by radiology via chest X-ray. In this scenario, the patient received a dual-chamber permanent pacemaker with a His lead implanted. There was no attempt to place an LV lead via the coronary sinus. Our question number one is, how is sequence number 14739, His, left bundle lead coded? Number one, not attempted. Number two, successfully implanted. Number three, previously implanted. Or number four, implant unsuccessful. Please take a moment to review the documentation, the question, and possible answers prior to making your selection. The answer is number two, successfully implanted. Despite the His lead dislodgement, the physician successfully implanted the His lead. The pacing and sensing thresholds were tested and found to be acceptable. In sequence 7735, lead location, the His bundle is selected to correctly identify the location of the lead in the upper right ventricle. Now, let us review how the His lead dislodgement impacts metric 36. In this scenario, the patient received a dual-chamber permanent pacemaker and the initial placement of the His bundle lead dislodged. It was repositioned in the septum. The pacing and sensing thresholds were tested and found to be acceptable. The patient is transferred to the recovery unit and discharged home once cleared by radiology via chest x-ray. Our question number two, is this patient included in the numerator of metric 36, proportion of pacemaker procedures where patient had an incidence of death or any adverse event? Is it number one, no? Or number two, yes? Please review the documentation, the question, and possible answers prior to making your selection. And the answer is number one, no. Despite the His lead dislodgement, the physician successfully implanted the His lead. The pacing and sensing thresholds were tested and found to be acceptable prior to the completion of the procedure. The coding instructions are met. However, the target value is not. Therefore, sequence 9260, lead dislodgement, is coded no. In this scenario, the patient met the denominator of metric 36 with the procedure type of initial generator implant with final device type of permanent pacemaker with a His bundle lead and will be included in the patient level drill down. The numerator is not met with the appropriate selection of no in sequence number 9260, lead dislodgement. A yes is required to be met. Metric 36 is a negative metric, meaning the goal is not to be included in the numerator. Thank you for viewing the EP device implant registry case scenario for March of 2022.

dual-chamber permanent pacemaker

His lead

lead dislodgement

pacing and sensing thresholds

adverse events