Under skin placement vs under muscle

Hi,

I have had my pacemaker fitted for 5 weeks now and I am very disappointed at how far it protrudes. I am unhappy because I feel it will affect me more than I had anticipated e.g. wearing a seat belt, carrying a backpack, playing sport, etc., as well as aesthetically.

I had my first follow up session today and explained my anxieties and have now been referred to the Consultant with a view to considering whether the pacemaker would be better placed below both the chest muscle layer and skin rather than just the skin, as it is now.

Does anyone have experience of having a pacemaker fitted below the chest muscle layer? And, if so, can you advise on the pro's and con's of each option?

I have not been able to find anything online so any advice would be greatly appreciated.

Thanks

7 Comments

placement

by Tracey_E - 2015-03-31 01:03:25

Mine is buried under the pectorals and I love it. It is sore for longer initially but imo it's well worth it in the long run. I don't even know it's there. However, I would give it more time before making a decision. They can settle in a lot in the first 6 months up to a year. Every surgery has a slight infection risk and you start over again healing, so I would wait a bit and see how it does before having another surgery.

Two downsides for me so far. I had my first one done in 1994. After several replacements, the scar tissue built up and was uncomfortable. When I had my last one (#4), a plastic surgeon rebuilt the pocket and cleaned up the scar tissue. I was pretty sore for a while after, but now it feels great again. Also, when a lead went bad it was a little more complicated to get a new one in since it's not at the surface.Not insurmountable and I'd definitely do it this way again, just letting you know the few times it was a nuisance.

If you decide to have it moved, see if you can get a plastic surgeon to do it. EP's know hearts, plastics know how to make things look and feel good. Go with the expert if you can get insurance to cover it.

Sticks out

by Theknotguy - 2015-03-31 01:03:56

Someone should be along who has the deeper implant and give you info on that.

My PM is just under the skin on the upper left side and it protrudes. Depending upon different definitions it protrudes anywhere from a little to a lot. Depending upon how hydrated I am, it can hardly be seen or stick out pretty far.

About eight months post implant we traveled to (of all places) the UK. Took the grand tour around the country via coach. So we were on the coach, off the coach, all over the place. Had to carry a backpack the whole time with meds and other I-don't-want-to-lose stuff. Maybe 20 plus pounds. Anyway, absolutely no problems with the shoulder strap laying across the PM.

Being in the US, we're more of a car culture, so I'm always going somewhere with the seat belt strap lying across my PM pocket. Once again, no problems with the PM. No pain, strain, or stretching.

After having been in two accidents, I'm not really concerned about the seat belt in the car lying across the PM pocket because you have absolutely no idea what is going to happen. You can do all sorts of speculation but you're just going to have to wait until the accident happens to find out. And, of course, I'm trying very hard to avoid any accidents, let alone the kind of accident that will cause the seat belt to activate.

From my side, at almost a year and a half in, I don't find the less invasive PM implant to be a problem with seat belt straps, backpack straps, or anything else.

Sub Pectoral

by PeteFindlay - 2015-03-31 04:03:03

Seems like you were unlucky not to even have that option discussed - it was suggested to me by my consultant as I was 'young' (about your age!) and active.

There is no sign of mine apart from the scar, and it is very well protected by the muscle. It hasn't stopped me doing anything - Crossfit, skydiving etc.

I have nothing to compare it with, but I'm glad I had it under the muscle.

There are some down-sides. It's a more involved, invasive operation, so (apparently) has a longer recovery - although it seemed quick and problem free to me. As I mentioned, nothing to compare it with. It'll also be more invasive when it come to changing the unit.

As to whether the benefits make it worthwhile going back into surgery to have the unit repositioned now, versus waiting to see how it settles, that's one for you to talk over with the consultant, I think. Definitely worth exploring the options though.

Sub Pectoral

by Ladyfish - 2015-04-04 12:04:23

I am 4 weeks out from a Subpectoral placement. My second CRT-D was replaced in late August 2014. There was considerable chest trauma removing the original CRT-D and the pocket was swollen and painful. I was told to ice it and take Tylenol.

The pacer began to migrate in December. My cardiologist and his peers said, "We don't do pocket revisions and we don't open the pocket unless we have to." The pacer continued to move sideways and upside down so I consulted with University of PA and Johns Hopkins specialists. Both said, "This needs fixed."

They were right. The leads were tangled and the LV lead was slightly abraded. The leads tested OK so they left them alone. The pacer was re-implanted below the pectoral muscle. The old pocket opening was quilted closed (that's what the record actually says). The Subpectoral has been great. No more pain or rubbing on the inside of the skin in my armpit.

I wish they had done this the first time. It would have been a lot more comfortable.

Good luck! If your EP doesn't take you seriously, find one that does!

Good luck!

Sub Pec

by Eggnation - 2015-04-04 12:04:53

I am 2 weeks post a Sub-pec implant.......I was fortunate enough to know someone who told me to ask this. I was not given the option and had to push for it. I think it is technically more challenging but very possible! I cannot compare but I am sure you have more muscle pain in the short term.

The tough thing for you is that you just went through the surgery- it will be challenging to convince them now to re-do it and would have been better for all if you did it only once!

Good luck! I am super happy with it sub pec and live in LA and go shirtless often, no one can tell..

Under skin placement vs under muscle

by Claret - 2015-04-26 07:04:21

Thanks everyone,
I see my consultant tomorrow and I am hoping he will agree to reposition it.

Don't be scared to ask

by Claret - 2015-04-27 02:04:13

Hi, Saw the Consultant today and he agreed immediately on examining the pacemaker that it protrudes significantly and would be better placed sub-pectorially.

Thanks everyone that helped, I feel much better now.

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