Operation

Hello.

I am a 25 year old man from Norway, so excuse my english if it isn`t that good;). I got my pacemaker (the little one) about two years ago. Lately I've gotten big complexes so i have decided having an pacemaker-operation to have it placed under the muscle. My "doctor" is though very skeptical about it, and says that it is like "playing with your life", and that one day the chances that it goes really bad(!) is extremely high. But i want to do this more than anything in my life, and it would mean a great deal to me. I was wondering if anybody has experience with this operation and could share some thoughts. Especially about the risk going through with it. Reading on this forum it seems like a pretty undramatic procedure.

Thanks for responding!

10 Comments

Subpectoral placement

by golden_snitch - 2014-04-27 03:04:29

Hi!

It IS a pretty undramatic surgery. It does hurt more afterwards than placing it just under the skin, but no pain that cannot be managed. Opening the pacer site up again, increases the risk for an infection. Usually, one says with every surgery this risk increases around 4%. But this would only be your second surgery, and with prophylactic I.V. antibiotics before the surgery (and maybe also afterwards) this risk can be minimized. Nevertheless, it's a surgery, and as with every surgery there are risks involved, and therefore you should not push for it, unless really necessary. But I'd not go as far as your doctor and say it's a surgery where you play with your life, and where something can go really bad. You should ask your surgeon, though, if he has performed subpectoral implants before, and how often. Maybe he's sceptical because he hasn't much experience with this?

I have had my pacemaker moved from under the skin to under the muscle. However, I would have not done this for cosmetical reasons only. My surgery was because I was having what they called 'mechanical irritations" causing pain with certain movements and when touching the area.

You'll always keep the scar. So, if you now want to have the pacemaker moved to a subpectoral pocket, you've got to be sure that it's really only the device sticking out that you cannot deal with; that this is what causes your complexes.

Best wishes
Inga

operation

by pace88 - 2014-04-27 03:04:37

Hi.

Thanks for fantastic response. Since im 25 years old i will have 4-5 operations i guess, so the risk clearly increases and when i hopefully get old one day the risk is actually pretty high, but i really think it`s worth it. But what does doctors mean by "risk". Do you die or is it that you "only" got infections that in the end can be healed? I dont know about his experience. I think he is a good surgeon, thats my impression.

The scar don`t bother me. Thats only cool:) Its the "bump" that annoys me and causes me bad quality of life.

Risks

by golden_snitch - 2014-04-27 04:04:58

The greatest risk in this case is the infection, I'd say. That might then lead to the whole pacemaker system including the leads having to be removed, couple of weeks on antibiotics, new implant on the opposite site. In a worst case scenario the infection could spread along the pacemaker leads into your heart, and do some damage there, for instance on the valves.

I'm 32, and have had eight pacemaker surgeries in the past 15 years. No infection ever. Cardio says statistically I'll one day suffer an infection, but that's just statistics. And with the batteries lasting longer and longer, and new pacemakers being developed, it is not even said that I'll need many more pacemaker surgeries. Could very well be that in 10-20 years there will be a battery that lasts forever. Who knows? There has been so much progress in cardiac rhythm device therapy in a comparatively short period of time.

Inga

operation

by pace88 - 2014-04-27 05:04:13

Thanks for great help:)

It's all good

by cheshirealice - 2014-04-27 05:04:35

The larger risks of infection is actually when you go into a pocket rather than making a new incision. The reason why is you may have some bacteria that was closed up and when you cut into that old pocket it increases your rate of infection. I think it's only 2-3% (at least that's what my Infectious Disease doc told me).

I am 27 yrs old and just had a sub-pec insert of my PM 1 month ago. The risky part of sub-pec is the general anesthesia. This is probably my 7th time going down under general anesthesia but I was just fine. My EP is VERY conservative and didn't want me to get the sub-pec but I couldn't be happier. Several of us on this site have had this operation and are very glad.

New type of Pacemaker

by Bistokid - 2014-04-27 06:04:35

St Judes have developed a new type of pacemaker which is inserted via one of the major blood vessels in the thigh into the heart chamber and has no wires. It is a simple procedure, and removal is the same.

General anaesthesia

by golden_snitch - 2014-04-28 01:04:26

You don't need a general anaesthesia for a subpectoral implant. A sedation combined with a local will do the same job, but put less stress on the body, and there is no intubation required. I have had subpectoral implants with a general, but the last two only with a sedation. For me it didn't make any difference, I slept through the whole procedure. But I recovered faster from the sedation than from the general anaesthesia.

The new pacemaker type by St. Jude (called Nanostim) is still in the stage where first implants in humans are performed. My EP implants them. At the moment, these pacers are single-chamber only, and are not for pacemaker dependant patients. But, of course, in a couple of years they might be for everyone, and then no more pocket is needed :-)


Inga

operation

by pace88 - 2014-04-28 12:04:34

Thanks again for the information! I`l take this with me to my surgeon. I am just a little curious about one last question. If you operate this device under your chest-muscle, will the muscle be elevated in any way? Or is that not noticeable?

Cosmetics of sub pectoral

by Pele - 2014-04-29 11:04:26

I chose a sub pectoral placement because I am very thin and felt the "bump" would mentally bother me and be very noticeable physically. I had one electro-cardiologist that tried to talk me out of it and another one that bent over backwards to help me find a surgeon to do it the way I wanted it done. My understanding is that most electro-cardiologists do the implants in clinics. My surgeon was very clear that whenever it is time to replace my device, it must be in a surgical theatre - not a clinic. I am very glad I went this route. The muscle is not elevated over the PM. There is a firmness of the skin in the area directly over the PM, but mine is not visually noticeable and no one would have a clue it is there. It is traumatic enough to need a pacemaker at a young age. I say if you are self conscious and unhappy with your current placement, try the sub pectoral solution whenever it is the right time for you.

operation

by pace88 - 2014-04-30 01:04:13

Thank you for the answer! That was good news, and i think sub-pectoral is the right solution for me;)

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