(If Other Cardiac Procedure, AFib = Yes ↓) Lesion location: Primarily epicardial Primarily Intracardiac OCarAFibLesLoc (4191) Method of Lesion Creation: (Select all that apply↓) Radiofrequency Yes No Bipolar Yes No (If Yes →) OCarAFibMethRad (4200) OCarAFibMethRadBi (4205) Cut-and-sew Yes No OCarAFibMethCAS (4210) Cryo Yes No OCarAFibMethCryo (4215) Lesions Documented: Yes No (If Yes ↓) OCarLesDoc (4240) Lesions: (check all that apply ↓) 1 Bilateral Pulmonary Vein Isolation 9 Intercaval Line to Tricuspid Annulus (“T” lesion) AFibLes1 (4250) AFibLes9 (4295) 2 Box Lesion Only 10 Tricuspid Cryo Lesion, Medial AFibLes2 (4255) AFibLes10 (4300) 3a Inferior Pulmonary Vein Connecting Lesion 11 Intercaval Line (SVC and IVC) AFibLes3a (4260) AFibLes11 (4305) 3b Superior Pulmonary Vein Connecting Lesion 12 Tricuspid Annular Line to RAA AFibLes3b (4265) AFibLes12 (4310) 4 Posterior Mitral Annular Line Lesion 13 Tricuspid Cryo Lesion AFibLes4 (4270) AFibLes13 (4315) 5 Pulmonary Vein Connecting Lesion to Anterior Mitral Annulus 14 RAA Ligation/Removal/Obliteration AFibLes5 (4275) AFibLes14 (4320) 6 Mitral Valve Annular Lesion 15a RAA Lateral Wall (Short) AFibLes6 (4280) AFibLes15a (4325) 7 LAA /Removal/Obliteration 15b RAA Lateral Wall to Lesion “T” AFibLes7 (4285) AFibLes15b (4330) 8 Pulmonary Vein to LAA Lesion 16 Coronary Sinus Lesion AFibLes8 (4290) AFitLesCSL (4336)
(If Other Cardiac Procedure, AFib = Yes ↓) Lesion location: Primarily epicardial Primarily Intracardiac OCarAFibLesLoc (4191) Method of Lesion Creation: (Select all that apply↓) Radiofrequency OCarAFibMethRad (4200) Yes No (If Yes →) Bipolar Yes No OCarAFibMethRadBi (4205) Cut-and-sew OCarAFibMethCAS (4210) Yes No Cryo OCarAFibMethCryo (4215) Yes No Lesions Documented: Yes No (If Yes ↓) OCarLesDoc (4240) Lesions: (check all that apply ↓) 1 Bilateral Pulmonary Vein Isolation AFibLes1 (4250) 9 Intercaval Line to Tricuspid Annulus (“T” lesion) AFibLes9 (4295) 2 Box Lesion Only AFibLes2 (4255) 10 Tricuspid Cryo Lesion, Medial AFibLes10 (4300) 3a Inferior Pulmonary Vein Connecting Lesion AFibLes3a (4260) 11 Intercaval Line (SVC and IVC) AFibLes11 (4305) 3b Superior Pulmonary Vein Connecting Lesion AFibLes3b (4265) 12 Tricuspid Annular Line to RAA AFibLes12 (4310) 4 Posterior Mitral Annular Line Lesion AFibLes4 (4270) 13 Tricuspid Cryo Lesion AFibLes13 (4315) 5 Pulmonary Vein Connecting Lesion to Anterior Mitral Annulus AFibLes5 (4275) 14 RAA Ligation/Removal/Obliteration AFibLes14 (4320) 6 Mitral Valve Annular Lesion AFibLes6 (4280) 15a RAA Lateral Wall (Short) AFibLes15a (4325) 7 LAA /Removal/Obliteration AFibLes7 (4285) 15b RAA Lateral Wall to “T” Lesion AFibLes15b (4330) 8 Pulmonary Vein to LAA Lesion AFibLes8 (4290) 16 Coronary Sinus Lesion AFitLesCSL (4336)
ACSD_NonAnnotatedDataCollectionFormV2_9.docx