UOHI Tools

“Every Cut is a Consult!” (Dr. M. Green, April 16 1949)

·      Indication for original pacing:

·      Original device implanted:

·      Original lead(s) implanted:

·      Are the lead parameters stable (sensing / threshold / impedance):  Yes / No 

o   Consider discussion of lead extraction / replacement.

·      Are the leads on advisory (eg. Riata, Fidelis 6949):  Yes / No

o   Consider discussion of lead extraction / replacement.

·      Is the patient dependent:  Yes / No

·      Percent of RV pacing: 

·      Indication for adding an A lead (eg. SND):   Yes / No / NA

·      Indication for upgrading to an ICD (eg. LV dysfunction): Yes / No / NA

·      Indication for upgrading to CRT (eg. CHF + RV pacing):  Yes / No / NA

o   Consider pre-operative ECG

o   Consider pre-operative echo

o   Consider pre-operative venogram (ordered through IR)

·      Indication for ICD placement : Primary / Secondary / NA

o   Ensure discussion about not replacing device, especially in the presence of comorbidities.

·      Assess anti-platelet / anticoagulation agents

o   Anti-coagulation agents à assess need to hold (usually NOAC LD D-2)

o   Anti-platelet agents à assess opporunity to hold pre-procedure

·      Examine device pocket (eg. Evidence of impending erosion / collaterals)

o   Consider sub-pectoral relocation etc… (will need anesthesia booking)

o   Consider pre-procedure venogram for device upgrade.

Patients to strongly consider: 

•Pacing dependent and EF < 50% (Block-HF patients) [includes post TAVI patients]

•Failed CRT (CS cannulation or unable to cannulate CS branch after a second operator has also tried or agreed)

•Recurrent heart failure and poor CRT QRS on ECG

Avoid in: HCM, Sarcoid, Septal MI, Amyloid

Post op programming: 

•ECG in unipolar and bipolar pacing

•Set to best morphology as assessed by morphology in V1 and LVAT in V5/V6 < 80 msec

•Document in post op recovery notes the LVAT measurement