Implantation question.

Implantation done 9 days ago. I saw the EP several days ago and he said he didn't make a pocket. He said where the device is will form a "capsule " He said I'm thin and a pocket couldn't be done. He has no concern about this. The device did move but it's still anchored. It was anchored some distance from the incision, ( maybe 1 in.)

I don't know much about devices, but I have not heard of no pocket and could not find it on a search. The only thing I found was some are so thin it has to be done behind the pectoral (I think.) I'm not that thin.

He didn't speak to me following the procedure and I'd think he would have told me of any problem.

He was recommended by my cardiologist whom I highly trust, am going to see this week and will ask him about this. 

Have you heard of this? My main concern is infection.

Thanks for your input 



I think your additional information tells us a lot.

by crustyg - 2020-11-22 05:31:22

Your PM has 'migrated' and now the implanting doc says that no pocket was created.  That's the problem in a nutshell.

Have a look at and the next section on how to actually create the pocket.

I'm thin and my EP doc created a pocket.  It's an important part of making sure that the PM does *NOT* migrate.  The pocket should be between two tough layers - the fascia, and a key consideration is preventing the leads (where they attach to the PM) from eroding up through the skin.  Fascia is much tougher than skin and keeping the PM still is part of preventing erosion.  If you are really thin (malabsorption, calorie restricted) then a sub-pectoral implantation would have been better.

If the PM's anchor stitch has allowed that much movement, it's not much of an anchor.  If your PM is subcutaneous that's not great.

I predict long term problems for you - with your PM and with the implanting doc.  I wouldn't go anywhere near him again.

Thanks crustg

by Pharnowa - 2020-11-22 13:39:20

Thanks for your well explained and documented response.

I will discuss with my cardiologist this week, bearing in mind he referred me. I will arrange a consultation with another EP to see if they recommend redoing the positioning.

I just keep thinking that my description of awful pain should have prompted someone to consider that something wasn't right. Instead, I think they thought I was either a weenie or drug seeking. Findng an EP willing to evaluate won't be easy, but I will certainly try.

Thank you.

What to do now?

by Gemita - 2020-11-23 07:10:03


Really helpful link on "How to Pace" from crustyg in a format that is easy to read and easy to understand.  I will definitely look at the other sections and keep a copy of the link in my Pacemaker file.  We are gathering information to have a meaningful conversation with our doctors, aren't we and this is exactly what we need to do.  

When you see your cardiologist, I would avoid saying anything unpleasant about the EP who did the procedure.  Just be diplomatic and maybe say something along the lines . . . "while I am sure my EP tried to do his very best, I do not believe the procedure went at all well since my pain levels have been intolerable at times.  I also do not believe that the device is in a good, secure position and this worries me for the future.  I would like to have the device re-positioned and made secure as soon as possible because it has clearly moved from its original site".  At this point throw in a few facts from the link crustyg has given us to support your case and get his attention.

My opinion is that if this is going to be put right, the sooner it is attempted the better.  I also feel that trust between your current EP and you has somewhat broken down and you would be better moving on.  When doubt starts to creep in, it is not a healthy sign.

Good luck with the cardiologist.  Maybe after your discussion he will be willing to refer you to another EP for an independent assessment

Points well taken.

by Pharnowa - 2020-11-23 09:00:17

Thank you, Gemita!

I agree I should not speak badly about the EP to my cardiologist,. He did d refer me. I actually like the EP as he's very nice. But, I prefer technical skill, of course 

The infomation crustyg provided is invaluable. Thank you both!



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