Welcome and thank you for taking the time to review the 2023 December case scenario for the EP Device Implant Registry. This scenario includes sequence number 7630, coronary sinus left ventricular lead. The patient was admitted for a CRTD generator change. The old LV lead was previously capped and abandoned. The implanting physician tried to place a new LV lead into several branches of the coronary sinus. However, the thresholds obtained were inadequate and the LV lead was removed. The RA and RV leads were used and connected to the CRTD. The patient was scheduled the next day for LV epicardiolead implantation in the OR. The question at hand is how is sequence number 7630 coded and what is the impact to metric 10? Number 1, the implant was unsuccessful and yes in the numerator. Number 2, not attempted, no in the numerator. Number 3, successful implant, no in the numerator. Or number 4, previously implanted, no in the numerator. Please take a few seconds to review the documentation in question. The answer is number 1, implant unsuccessful, yes in the numerator. Any attempt to implant the LV lead via the coronary sinus will be captured even if the patient has an existing LV lead. Let's look at metric number 10 on the dashboard. When reviewing the measures and metrics and or detail lines for any registry, it's best practice and imperative to have the companion guides handy to review and refer to when evaluating the metric feedback. When evaluating your data, the general goal is to be above the 50th percentile. This site performance is 2.5% which is above the 50th percentile at 3.5%. The goal of this metric is to have a lower percentage number. Let us select patient details to drill down on this metric. The patient detail is reviewed with an ending time frame of 2023-Q3 and has one case that is coded as an unsuccessful attempt to place the coronary sinus or left ventricular lead in 2023-Q2. To see how this facility compares to like facilities and the national aggregate, let's look at detail lines number 1535 with a published quarter report. Reviewing the published quarter of 2023-Q2, there are two cases within the rolling four quarters. This measure assesses the hospital's rate of failure to successfully place a coronary sinus or left ventricular lead. This unadjusted outcome metric is intended to be used for quality improvement. The facility rolling four quarters on the metric 10, proportion of defibrillator lab visits with an unsuccessful attempt to place the coronary sinus or left ventricular lead, is 3.9%. The result of the rolling four quarters for the facility is reviewed at 3.9%. The U.S. volume group rolling four quarter is reporting as 6.2% and U.S. registry rolling four quarter is at 6%. Thank you for reviewing the 2023 December case scenario regarding sequence 7630, coronary sinus left ventricular leads in metric 10 failure to place coronary sinus and LV lead.

EP Device Implant Registry

case scenarios

dual-chamber permanent pacemaker

lead dislodgement

RV lead

CRTD generator change

left ventricular lead

right atrium lead

right ventricle lead

unsuccessful attempts