![]() The Mantel-Haenszel methods are the fixed-effect methods used when event rates are low or study size is small, as the estimates of the standard errors of the effect estimates that are used in the inverse variance methods may be poor. Discrepancies were resolved by discussion or adjudication by a third author (J.C.H.).ĭata was summarized across treatment arms using the Mantel-Haenszel risk ratio (RR), inverse variance mean difference (MD). and O.M.A.) independently assessed the risk of bias of the included trials using standard criteria defined in the Cochrane Handbook for Systematic Reviews of Interventions. and O.M.A.) independently assessed the quality items and discrepancies were resolved by consensus or involvement of a third reviewer (J.C.H), if necessary. Disagreements were resolved by consensus. Information was gathered using standardized protocol and reporting forms. Outcomes were extracted from original manuscripts and supplementary data. and O.M.A.) independently performed literature search and extracted data from eligible studies. We aimed to compare the efficacy and safety between LAAW and LMI lines. The studies had to fulfill the following criteria to be considered in the analysis: (1) Studies had to have compared outcomes in patients who underwent ablation with LAAW versus LMI lesion sets (2) Studies had to have compared and reported rates of achieving bidirectional block, ablation times, ablation line length, LAA activation delay, rates of pericardial effusions, and/or maintenance of sinus rhythm (3) Studies must have been published in a peer-reviewed scientific journal. The PRISMA statement for reporting systemic reviews and meta-analyses was applied to the methods for this study. Studies were selected by two independent reviewers. Search terms included ( Mitral Annular Flutter OR Atrial Fibrillation) and ( Mitral Isthmus Ablation or Anterior Mitral Ablation) and ( Catheter Ablation). The reference list of all eligible studies was also reviewed. We searched PubMed,, Medline, Google Scholar, and the Cochrane Central Register of Clinical Trials (Cochrane Library, Issue 09, 2017). The purpose of our current study was to perform a systematic review of the literature and meta-analysis to compare the efficacy and safety of both approaches. Both approaches have been shown to be effective, but the LMI line often requires additional coronary sinus (CS) ablation to achieve bidirectional block. While the LAAW line is drawn between the anterior mitral isthmus and right superior pulmonary vein (or occasionally the left superior pulmonary vein or roof line), the LMI line is drawn between the left lower pulmonary vein and LMI. The two most common approaches for ablation of peri-mitral flutter include a left atrial anterior wall (LAAW) line and a lateral mitral isthmus (LMI) line. MAF is often resistant to both rate-controlling and antiarrhythmic drugs, thus necessitating catheter ablation for treatment. Note: We do not guarantee that all questions will be answered.Mitral annular flutter (MAF) is the most common left atrial macro-reentrant atrial arrhythmia following catheter ablation of atrial fibrillation (AF). Need expert advice? Email your questions for consideration in the Revenue Cycle Daily Advisor. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment. This answer was provided based on limited information. 02584ZZ, Destruction of conduction mechanism, percutaneous endoscopic approachĮditor’s note: Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, CCDS-O, HCS-D, director of HIM and coding for HCPro in Middleton, Massachusetts, answered this question.02583ZZ, Destruction of conduction mechanism, percutaneous approach.02580ZZ, Destruction of conduction mechanism, open approach.This procedure can be reported with the following ICD-10-PCS codes: The ablation procedure is directed at the pathway for electrical impulses rather the muscular wall of the heart itself. However, according to Coding Clinic, Third Quarter 2016, the body part being treated is actually the atrioventricular node, which is assigned to body part character 8: conduction mechanism. When ablation procedures are performed to treat AF, it would seem like the body part value would be the atrium (right or left). In ICD-10-PCS, ablation procedures for treatment of AF are assigned to the root operation Destruction (the physical eradication of all or a portion of a body part by the direct use of energy, force, or a destructive agent). How should we report this in ICD-10-PCS?Ī: An ablation is a common form of treatment for AF. Q: We have a patient who was admitted for an ablation procedure in order to treat his atrial fibrillation (AF).
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