Under the muscle vs on top?

Hi
Eleven weeks ago I had a lead revision to my Medtronic Adapta pacer. I am paced 99% of the time from the ventricle and that lead went bad. I am 41 and have had a pacer for 6 years with two lead revisions and one pacer upgrade.

My Doc removed the bad lead and then placed the devise under my pec. Well at about week 5 I thought it moved, followed up decided to play it conservative and waited 5 more weeks. I have considerable swelling, weakness and pain. Apparently it has dislodged (he used disolvable sutures) and now it is between the pectoral muscles. For you ladies, I struggle to hold 4 blouses on hangers while shopping.

I do cardio and weights 6 days a week. Prior to the lead revision I was doing 80 push ups. Now I can't do any.

I go back into the hospital on Friday this week and he is going to move it.

My questions are: Does anyone else who is athletic and fit have theirs under the muscle? Any problems with weightlifting? Was the recovery miserable?

Has anyone had it under the muscle and then moved back on top? I was able to work out fine but my upper body is not very meaty and the pacer protruded and occasionally poked. But the recovery is much easier.

Any advise?
fitgirl

12 Comments

ops...

by turboz24 - 2009-10-14 09:10:20

Make that ~guin. TraceyE is on this site......

not under, but maybe later...

by turboz24 - 2009-10-14 09:10:39

I've wondered the same thing about weight lifting and having the device under the pec major. Mine is uncomfortable on top and looks horrible, but I don't necessarly want to trade one issue for another.

I mean, on top, sure I can never take off my shirt in private or public, but it's not really painful most of the time, just uncomfortable. I'd hate to change that to sure you can't see it anymore, but not at the cost of any serious constant pain.

TracyE on the ICD forums has hers implanted sub-pectorally, but she also doesn't workout a ton. I think she works out, but not heavier/hard core type lifting.

Workouts w under muscle

by ElectricFrank - 2009-10-14 10:10:40

The problem with under the muscle is that the pacer is trapped between the pec and the rib cage. This is OK until a workout causes heavy contractions in the pec and then ouch.

I'm surprised he used disolvable sutures on the pacer. They are fine in closing an incision where the tissue grows together and the need is temporary, but the sutures at the pacer have a permanent job holding it in place.

frank

I did

by golden_snitch - 2009-10-15 01:10:56

Hey!

Yes, I had revision surgery with a sub-pectorally placed pacer. As I said it had moved into my armpit so the surgeon took it out and then made a new pocket under the pectoralis muscle but more centred (left of the sternum). He did say since this was the fifth pacer surgery on the left side within less than ten years, that some "collateral damage" was impossible to avoid. There was lots of scar tissue etc. It did hurt a lot afterwards. I stayed in hospital for three days and got some i.v. pain meds, and then at home I needed painkillers for another two weeks.

I'm sorry that I can't tell you anything more encouraging. Is there a reason why the surgeon had placed your new pacer under the muscle? Because if there isn't any particular reason, you might just want to go for a subcutaeneous placement again.

Best wishes
Inga

subpectoral placement

by golden_snitch - 2009-10-15 03:10:17

Hi!

I don't think it is trapped between pectoralis muscle and rib cage. I have my pacer under the pectoralis major muscle and on the pectoralis minor (and attached to that with sutures) so it's between those two muscles. There is the possibility of attaching it to a rib but that's something surgeons really try to avoid because it causes problems.

My pacer moved back in July, and I suddenly had it under my armpit. The problem was - that's what the chief of the department for cardiac surgeries said who did the revision surgery - that the surgeon who had done the last surgery hadn't attached the pacer to the muscle with sutures. Apparently pacers even have a little picot through which a thread can be pulled and then the pacer can be sewn on the muscle. So that's what he did this time, and until now all is well.

I can work out, but after surgeries where they cut into the muscle (they have to do that to place the pacer under the muscle) it's takes way longer to recover and gain back strength etc. So maybe you need a few more weeks.

Best wishes
Inga

Long term under the muscle

by kmstam - 2009-10-15 03:10:50

I have had 4 procedures in 6 years and the thinking was that under the muscle would be better protected. I agreed because...Occasionally the pacer poked me as I am not very meaty.

After the procedure in July I had a lot of pain and my blood pressure tanked for about 4 hours after the procedure in late July but he removed the bad lead and replaced it (the thinking was that if every 6 years my leads will go bad that by the time I am 66 my heart would be a junk yard of old wires.) I hope that was the cause of all the pain.

He said that if there was enough tissue he could put it back subcutaneously I just wonder long term which is best? Inga how long had your pacer been in place before it moved (under your arm pit-ouch)?

Has anyone had theirs under the pectorals without issue for a number of years?

Thanks for any input.
Kristy

long term buried deep

by Tracey_E - 2009-10-15 05:10:28

I'm sorry I didn't chime in sooner, not sure how I missed this! Mine is behind the breast, under both muscle and breast tissue, has been there since 1993 and through 3 replacements.

It's put in from the side (scar is about where the underwire of my bra hits) and tunneled under/posterior to the breast. Recovery was longer than average but I would not say it was more painful. I never took more than Tylenol after the first day or two. I was mostly back to full movement within 6 weeks, felt a twinge if I stretched the wrong way. By 3 months until I was doing my full workout again and could forget it was there.

I don't get discomfort from it for the most part, even carrying heavy backpacks and doing pushups. I've aggravated it a time or two when I overdid it with something new (like the week we bought the Wii) but for the most part I only know it's there when I pms. It doesn't hurt, more of an awareness.

Recovery under the muscle

by kmstam - 2009-10-15 12:10:59

Thanks for all of the comments.
My doc is definately going to use permanant sutures tomorrow.

I am not sure that I am mentally prepared for the tremendous pain and long recovery if he puts it back under the muscle. Perhaps if it stays in the appropriate place and since the muscle has already been compromised, the pain won't be as bad. Has anyone had a replacement or revision with it under the pec. muscle? Was it as bad the second time around?

I just started a new job 8 weeks ago so have concern about a long recovery.

how long...

by golden_snitch - 2009-10-16 02:10:07

Hi Kristy!

Well, the pacer that moved had been in for just four months. But I have had a pacer placed subpectorally before that was in for about six years with no problems at all.

Best wishes
Inga

Much Better

by kmstam - 2009-10-18 06:10:26

Thank you all for your comments.
I had my procedure Friday and had the PM moved from behind/between the muscle to subcutaneous. Apparently it had not moved but was very near the collarbone and "it must have been sitting on a nerve" my doc said.

I feel so much better, have restored strength in left hand and arm already. It is amazing. I am so thankful that I am not even crabby that immediately after surgery in July when my BP tanked and sat at 60/30 for 4 hours and I suggested that I thought it was on a nerve...no one listened. Additionally the week after when my hand and arm were numb and my fingers swollen...again, I thought nerve pain...Even two weeks ago when the swelling was still present near the site I asked if it was possible to do a nerve conduction study....He just thought that it had moved.?

Anyway, I am reassured that I know my 41 year old body better than anyone else and I will persist if my body is sending me signals.

I can fully use my left hand, my arm is good, my hands strong, my site looks good, I plan to return to work Monday evening.

Thanks again for your comments and support.
Kristy

excellent!!

by Tracey_E - 2009-10-19 09:10:01

So glad to hear it went well and you are on the mend!!!! We usually know our own bodies best, it's frustrating when it takes so long to convince them.

moved for Army

by wrholder - 2009-11-07 09:11:40

I had my pacer implanted on 13 Apr 09 below skin (above) pec muscle and then on 29 Oct 09 I had it relocated under my pec to stay in the Army. This was the guidance given to me by the Army to stay on active duty. I have def. more sore this time around but expect a full recovery.

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