CRF procedure PROCEDURE FLOW. PATIENT ASSESSMENT Symptoms and indication. Pacemaker & ICD registration. Procedures. Procedure ICD.
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1 Pacemaker & ICD registration Procedures CRF procedure PROCEDURE FLOW Procedure ICD ICD PM ICM lead only PATIENT ASSESSMENT Symptoms and indication Symptoms and events (multiple possibilities) Asymptomatic no Fatigue no Palpitations no Dyspnoe no Chest pain no near / pre syncope / dizziness no Syncope no Chronic heart failure no Systemic embolic event no Cardiac arrest / aborted sudden death no Other no If symptom, specify ICD indication prophylactic therapeutic PM indication? no PM indication (multiple possibilities) Bradycardia no AV block no Heart failure no Afib no
2 Acute MI no Severe electrolyte disturbance no Other no If indication, specify If bradycardia, indicate sinus node dysfunction AV conduction disturbance binodal disease drug induced bradycardia If AV block, indicate first degree AVB second degree AVB Mobitz type I (Wenckebach) second degree AVB Mobitz type II (Infranodal) complete AV block Pre implantation Ejection Fraction assessed? no LV EF (%) Method MRI Nuclear LV angio Echo CT PROCEDURE AND HOSPITAL ADMISSION Procedure and hospital admission Date of procedure Second stage procedure? no Hospital in which this procedure was performed PatientID in implanting hospital
3 Implanted by Antibiotic no Antibiotics (multiple possibilities) pre/perioperative no postoperative no Device Type of device procedure implantation explantation replacement reposition upgrade with device change upgrade without device change activation deactivation pocket revision attempt to procedure If upgrade, type of upgrade upgrade from PM to ICD upgrade from PM to CRT D upgrade from CRT P to CRT D upgrade from ICD to CRT D upgrade from VVI ICD to DDD ICD Brand name device Other If brand name, specify Model device Other Other CRT: NO If model, specify Serial number device Leadless device? no
4 Device (inactive) Reason for replacement / explantation / reposition device not applicable normal End Of Service premature End Of Service sensing / pacing failure failure to defibrillate software (algorithm) failure connector failure recall skin erosion / infection systemic infection / endocarditis elective (patient request) pocket hematoma pain damage from extrinsic energy elective system change electrode problem system change hemodynamic If reason, specify Therapy ATP therapy? TESTING Testing Activated (Defibrillation Test) no no Succesful tested shock (DF Test Success) no
5 Lead form Lead type Extra lead RA lead RV lead Subcutaneous array LV lead Extra lead Unknown Type extra lead RA lead RV lead LV lead defib lead VDD CS lead If type, specify Type of procedure implantation explantation replacement reposition repair activation deactivation reposition tip attempt to procedure new adapater adapter removal new extension extension removal Brand name Other If brand name, specify Model name Other If model, specify Serial number
6 Reason lead replacement / reposition / explantation not applicable normal End Of Service premature End Of Service upgrade to dual chamber upgrade to biventricular / CRT upgrade atrial therapy sensing / pacing failure failure to defibrillate software (algorithm) failure connector failure recall skin erosion / infection systemic infection / endocarditis intravascular constriction macro or micro lead dislodgement pain damage from extrinsic energy fibrosis at electrode myocordial interface lead failure retention with fracture chronic perforation oversensing T wave oversensing R wave in atrial channel diaphragm stimulation If reason, specify Method of making lead inactive capping cutting and capping removal Submit NCDR All rights reserved.
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