Subdermal vs Subpectoral

Fairly new to this site and I've seen subdermal & sebpectoral mentioned. Is this something decided between patient and doc or not ? I'm on a waiting list but no idea if there will be a pre op chat as there wasn't for my ablation back in March.


You have to lead this conversation

by crustyg - 2020-11-26 13:21:04

Unless you raise this you'll get your PM placed where it's most commonly implanted.

Your EP doc may well push back on any other placement, and I'm told that sub-pectoral is *much* more painful for the first few weeks.  You need to have some compelling arguments/logic/reason why it shouldn't be placed in the usual position.  Doesn't mean that you can't get it implanted to a different pocket location, but it's not a simple matter of choosing two equally good locations - it impacts both you and your EP doc.

Search some of the other historical posts about this for other people's experience.


Device position

by Gemita - 2020-11-26 14:50:19

Sandoval, I agree with crustyg’s comments.  

I would learn as much as you can about your choices and then there is no harm asking about what options are available to you.  Looking through Pacemaker Club old posts, a deeper placement is cosmetically more acceptable and longer term potentially more comfortable, once you get over the initial hurdle of longer recovery and more discomfort from a deeper placement.  Remember in the future it may not be so straightforward to replace the device though and I am not sure whether you can go from subpectoral to subdermal, so there are questions to ask.

I wasn’t given a choice where my device would be placed, but I did have a pre op in my London hospital because my EP wanted to implant under a general anaesthetic.  During pre op I was able to chat freely with a doctor about what would be happening during implant and I had all the necessary checks at the same time:  bloods, X-ray.  

Because of your potential CRT-D pacemaker however, I do feel that you will have the opportunity to be called in prior to your implant.  As soon as you get your date through I would ask about a pre-op, so that you can ask lots of questions this time.  It sounds as though you really need to do this.

Personally if I may say so Sandoval, I feel that it is more important to focus on getting the right device before you worry about subdermal/subpectoral positioning.  The correct device will make such a difference to your quality of life.  Maybe the device choice (CRT-P or CRT-D) will determine in any event where the device can be placed?  Only my opinion Sandoval, but I hope this helps.

Sub pec

by ar_vin - 2020-11-28 16:45:52

If at all you're physically active in the outdoors (climbing, scrambling etc, wearing a pack), you should request a sub-pec implant. I requested my EP for a sub-pec implant and he agreed based on my active lifestyle. 

I have no way to compare sub-pec vs sub-dermal but sub-pec was not particularly painful. The night after the implant I was kept in the hospital and offered all kinds of pain medication. I refused all pain meds but requested ice packs. The ice packs made me comfortable enough to fall asleep. Once I got home the next morning and showered I felt much better. The incision was sealed with surgical glue and I was told I could shower any time I wanted.

Please don't let short term pain during recovery deter you from a sub-pec implant if that's what would help your lifestyle.



Sun pec

by sandoval - 2020-11-28 22:17:59

Ar_vin - I don't do scrambling or climbing but I carry a golf bag around with the strap over my left shoulder for a few hours a few times a week. Of course I realise I can't play for several weeks anyway so not sure if it would make any difference after the site has healed.  I'll ask and see what response I get.

You know you're wired when...

Your old device becomes a paper weight for your desk.

Member Quotes

I'm a runner, mountain climber, kayaker, snow skier, bicycler and scuba diver. The only activity among those that I'm not yet cleared to do is scuba diving, and when I am cleared, I'll be limited to diving to 50 feet.