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SUMMARY: With
the patient supine on the operating table under adequate sedation, 20 cc of 1% local was infiltrated in the left infraclavicular region. This was done after prepping with DuraPrep solution, sterile sheets, towels, and Ioban drape. A transverse incision was made
under the left clavicular area. We gained access to the subclavian vein with a needle, and placed a wire into the superior vena
cava. After we did that, we placed a lead into the right ventricle and screwed the lead out. We placed a lead into the
right atrium and screwed the lead out.
In the right atrium, we had a P wave of 1.6 millivolts, 560 ohms impedance. We were able to pace the atrium to 0.8 volts. The R wave was 8.8 volts with impedance of 1392 ohms and a threshold of 1.2 volts. These 2 leads were attached to the device and tightened down properly. This was placed into the subcutaneous pocket which we
have made. After ensuring proper hemostasis, we closed the wound in layers with 2-0 Vicryl in the deep tissue, 3-0 Vicryl in
the subcutaneous. The skin was closed with running 4-0 Monocryl subcuticular stitch. The fluoroscopic unit was used for
a total of 3 minutes for the placement of the leads. The patient tolerated the procedure well with less than 25 cc in blood
loss and was taken to the recovery room and awakened in good condition with the device sensing the patient properly with lower rate
limits of 60, upper rate 120.
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