Pacemaker Implant

What's the best way to install a pacemaker on left side (I'm right handed) to minimize bump. I've heard of subpectoral muscle implants and transaxillary percutaneous techniques but don't know the advantages/disadvantages of either over the standard under the skin placement.

I figure if I gotta have one of these things, I might as well make is as aesthetically pleasing as possible. Also, does insurance cover these approaches if they are considered more cosmetic?

Got procedure scheduled this coming Friday so I got some decisions to make.

4 Comments

Followup

by gaman - 2015-04-06 09:04:08

Thanks for the good info.

Also note the following:

1. I'm a 54 yr old male of slim build.
2. Had tricuspid valve repair 5 months ago and am in complete heart block. However, I'm virtually asymtomatic except for not feeling real good. Workout and go to work as usual. Never fainted or even been dizzy. Average 45-48 bpm at rest.
3. Dual pacemaker will pace right atrium and a lead will be run thru coronary sinus instead of thru my repaired tricuspid valve to stimulate the left ventricle.

Dr. said I could be back at work on Monday. I'll ask him but I gotta assume that means driving is ok. My take is that they definitely want patients who have been passing out to wait on driving until the pacemaker proves itself.........I've never passed out. I'll check with his office about the alternate pacemaker pocket sites tomorrow.

talk to the surgeon

by Tracey_E - 2015-04-06 09:04:54

Have a talk with your surgeon and let him/her know that how it looks and feels is important to you. There is no best way- it depends on your build, your surgeon, the size of the device. Mine is buried and I love it.

The main disadvantage to putting it under muscle is healing time. It's more sore and sore for longer, but imo it wasn't that bad and in the end well worth it. When I needed a lead replaced, it was a little more complicated. The biggest advantage is the scar is hidden and there's no lump. It never gets in my way when I'm working out or hiking with a heavy backpack.

Subcutaneous is easier, faster, heals the fastest, and has the smallest chance of infection. Left side is easier than right side because it's closest to the heart. Unless there's a reason to go on the right side, they usually put it on the left whether you're right or left handed. Once you heal, it's all the same.

Sometimes, again depending on your build and the size of the device, they can go a little lower and a little deeper without going all the way under the pectoral. This is a good compromise if it will work for you. Also by putting the incision a little lower, they can angle it so that it's covered by a tank top.They can also put it closer to the armpit.

If your EP does the alternate placement, the cost should be the same so insurance shouldn't be a problem. When I got my first one, I was young and very underweight so my surgeon was concerned how it would look. He had never done an alternate placement so he brought in a plastic surgeon. I expected to pay him out of pocket but insurance covered it. When I had my 4th replacement this last time, the scar tissue had built up and was getting uncomfortable so they brought in the plastic to clean it up and rebuilt the pocket. Again, I went into it expecting to pay out of pocket but insurance paid it.

If your dr seems at all hesitant, ask about having a plastic surgeon. Some drs are weird about bringing in help but some like mine are relieved to not have to deal with more than getting the pm and leads where they're supposed to be.

The most important thing is to speak up asap!! Not Fri as they're wheeling you in, that's too late. More drs think about placement and take care with how it looks than used to, but many still go the easiest way unless you tell them you want something else.

Work

by gaman - 2015-04-07 01:04:12

Have to play it by ear on the work but we'll see.......got a lot on my plate so I can't afford to miss too much.

I understand the coronary sinus leads are pretty thin. Is there any better protection of leads going the subpectoral vs subcutaneous route? I understand any malfunction requiring lead removal out of coronary sinus is pretty tricky after a few years (more tricky than the normal leads). Also, I'll ask surgeon but assume it's good to not overdo upper body exercise as that would seem to put bending stresses on leads.

I would think it shouldn't be a big deal for a major hospital in Atlanta to install pacemaker either subpectorally or subcutaneously. I'm waiting to hear from them in regards to my Friday procedure.

driving

by Tracey_E - 2015-04-07 08:04:17

I was never told no driving but it was about a week until I felt up to it. Some find the seat belt puts pressure on sore spots. Play it by ear. It's great that you can go back to work Monday but you might want a few days more. Can you do half days if you don't feel up to a full day that soon? Most are surprised how tired they are. Not necessarily feeling bad, just wiped out. I napped a lot those first two weeks.

If you are a small build and/or don't have much padding, they might have to go under the pectoral if you want it out of the way.

Good luck!!! Let us know how it goes.

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