The June case scenario will review EP Device Implant Registry Sequence 9001 intra-post-procedure events. An 88-year-old female was admitted for shortness of breath and a planned CRTD implant on May 5, 2025. The patient has a history of STEMI on December 2024 with a stent placed to their proximal and NYHA Class 3 on guideline medical therapy per the Implanting Physician Documentation. The current left ventricular ejection fraction is 25% three days prior at the office visit. During the CRTD implant procedure, the right femoral artery is accessed for arterial line pressure monitoring as attempts at both radial arteries failed. During recovery, a right side femoral hematoma is identified and manual pressure applied. The patient was admitted to stay overnight and a change of shift and ultrasound of the hematoma area revealed a pseudoaneurysm. The surgical vascular team was notified and performed a thrombin injection. The patient was monitored and discharged on 5-8-25. Our first question, are any of the complications experienced by the patient abstracted as an intra- or post-procedure event? Number one, no. Or number two, yes. Please take a moment to review the documentation and question before selecting your final answer. And the answer is number two, yes. Intra- or post-procedure events are captured as the definition is met and target value of any occurrence between start of procedure and until next procedure or discharge is met. Our second question, which events are coded as yes in sequence 9002, intra- or post-procedure events, of the five listed below? One, bleeding access site, two, bleeding retroperitoneal, three, hematoma, four, vascular complications, and or five, urgent cardiac surgery. Please take a moment to review the documentation and question before making your final answer. And the correct selections are number one and number four. Number one, bleeding access site, and number four, vascular complications. Now let us review the rationale of why selections one and four are correct and why two, three, and five are not. The intent of the bleeding events any in the EP device implant registry is to capture a bleeding event. To qualify, the bleed must be observed and documented in the medical record between the start of procedure and until the next procedure or discharge and associated with any one of the following. A hemoglobin drop of greater than or equal to three grams per deciliter, transfusion of whole blood or packed red blood cells, or a procedure intervention or surgery at the bleeding site to reverse, stop, or correct the bleeding, such as surgical closures, exploration of the arteriotomy site, balloon angioplasty to seal an arterial tear, or endoscopy with cautery of a GI bleed. Hematoma is not met as it is only coded yes if there is documentation that the patient experienced a pocket hematoma at the incision site requiring a reoperation, evacuation, or transfusion. A retroperitoneal bleed is also not collected as it is only coded yes if the patient experienced a retroperitoneal bleeding event observed and documented in the medical record. Urgent cardiac surgery is not collected here either as it is coded yes if there is documentation that the patient required an unplanned or emergent cardiac surgery. Our question number three, how are sequence 1578-4 vascular complication location and sequence 1578-3 vascular complication intervention type coded? Number one, groin and endovascular repair. Number two, groin and surgical repair. Number three, groin and thrombin injection. Or number four, none. Please take a moment to review the documentation and question before making your final determination. And the answer is number three, groin for the vascular complication location, sequence 1578-4, and thrombin injection for the vascular complication intervention type in sequence 1578-3. Thank you for viewing the EP device implant registry case scenario for June of 2025.

bradycardia

pacemaker

myocardial infarction

ejection fraction

EPDI registry

CRTD implant

vascular complications

thrombin injection

pseudoaneurysm

femoral hematoma