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33263 vs 33249- CRT-D Replacement

Date: Mar 14, 2023


He has had prior placement of CRT-D device which is at ERI status. Biventricular pacing percentages were at 97% and is presented today for generator change. He has preerosive changes on his device and leads. He has had a well-functioning CRT-D device with an abandoned prior RV lead. His abandon lead was originally placed in the submuscular pocket, we then changed out the device pacing through the prior LV lead. Through the device the leads were interrogated, the patient was in underlying atrial fibrillation with fibrillatory waves at 1 mV. Lead impedance was 390 and stable. The RV lead showed no sensed R waves at VVI 30 pacing threshold of 0.75 V at 0.5 ms and an impedance of 430 ohms. The LV lead showed a threshold of 1.5 V at 1 ms impedance of 600 ohms and high-voltage impedance was 55 ohms. Bradycardia parameters were set DDIR with a lower rate limit of 70 VT monitor was set at 160 VF zone at 200. Standard outputs were programmed with the device. No immediate complications of the procedure. 

33263? 33264? or 33249?

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