Welcome, and thank you for taking the time to review the 2023 October case scenario for the EP device implant registry regarding sequence 14731 reason pacing indicated for the procedure involving a CRTD implant. In this scenario, a 58-year-old female was admitted with shortness of breath and with a history of non-ischemic cardiomyopathy and has been on guideline-recommended medical therapy for two years. Her lower extremity swelling is worsening with New York Heart Association functional classification 3. During this admission, an angiogram revealed normal coronary arteries, and the ejection fraction is 28%. Due to the induced sustained monomorphic ventricular tachycardia during the EP study and worsening symptoms of heart failure, the clinicians documented plan schedule the Bi-V ICD implant for CRT cardiac resynchronization therapy since the patient's heart failure symptom was not responsive to the medical therapy. The patient agreed after a shared decision-making conversation occurred. Our question is how is sequence 14731 reason pacing indicated coded? Number one, sick sinus syndrome. Number two, complete heart block. Number three, chronotropic incompetence. Number four, Mobitz type 2. Number five, 2 to 1 AV block. Number six, atrioventricular node ablation. Number seven, heart failure unresponsive to guideline-directed medical therapy. Problem number eight, anticipated requirement of greater than 40% RV pacing. We will review the selection before we answer the question. To select sick sinus syndrome, the patient must be symptomatic, and this may include sinus bradycardia, ectopic atrial bradycardia, sinoatrial exit block, sinus pause, sinus node arrest, and tachycardia bradycardia syndrome. Complete heart block is defined as no evidence of intrinsic atrioventricular conduction, which includes symptomatic first-degree heart block. Mobitz type 2 is a type of second-degree atrioventricular block, which refers to a cardiac arrhythmia that reflects a conduction block at the atrioventricular AV node. The characteristic is P waves with a constant rate less than 100 beats per minute and with a periodic single non-conducted P wave associated with other P waves before and after the non-conducted P wave with constant PR intervals, excluding the 2 to 1 atrioventricular block. 2 to 1 AV block has P waves with a constant rate or near constant rate because of ventriculophasic sinus arrhythmia less than 100 beats per minute, where every other P wave conducts to the ventricles. Chronotropic incompetence is broadly defined as the inability of the heart to increase its rate commensurate with increased activity or demand failure to attain 80% of the expected heart rate reserved during exercise. The condition affects 20% to 60% of patients. Chronotropic incompetence is also coded if there's documentation of pharmacological rate control and or the patient is unable to tolerate the needed pharmacological therapy. Atrioventricular node ablation is used when heart block is induced by AV node ablation. Heart failure unresponsive to guideline-directed medical therapy is documentation of a device being implanted to treat heart failure unresponsive to guideline-directed medical therapy. The last selection is the anticipated requirement of a greater than 40% RV pacing, which requires documentation of anticipated RV pacing greater than 40% or treating heart failure unresponsive to guideline-directed medical therapy or documented treatment with resynchronization therapy. Please take a moment to review the documentation and then choose your response. The answer is selections seven and eight. And the rationale is the documentation recommending a Bi-V ICD implant for CRT, that's cardiac resynchronization therapy, and heart failure unresponsive to medical therapy is sufficient to select heart failure unresponsive to guideline-directed medical therapy and anticipated requirement of greater than 40% RV pacing. Thank you for viewing the 2023 October case scenario regarding sequence 14731 reason pacing indicated.

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