Guitars, seatbelts, and subpectoral implant

Hi All!

Still working through my diagnosis (asymptomatic, vagal-mediated AV block) with my doctor but I wanted to float a few questions. I am in the "acceptance" phase and my goal is to get through surgery and recovery as easily as possible and get back to doing the stuff I like doing.

I am 5'10 about 140 lbs, fit but thin. One doctor kind of rolled his eyes when I asked about subpectoral implantation of a dual chamber PM. He says he does them, but said it's just "more pain". This doctor is supposedly very good but I was taken aback at his tendency toward subdermal.

1) I want to bury this thing. Does going in subpec, if you have decently defined pectoral muscles, make sense? Is it going to pose more irritation if it's under a larger muscle? I've only seen a handful of before/after subpectoral, and some of the more body-builder types have them subdermal and wear their PMs proud.

2) If I go subpec, that's going to help with irritation in the long term I'd think? More padding would let me wear my guitar strap and seatbelt vs potentially rubbing against my PM-protruding skin?

3) The doctor also said PMs tend to migrate more if they are subpectorally implanted. This makes *zero* sense to me, why wouldn't he suture down the PM all the same?

If any guitar/bass players can chime in, whether you have a subpec or subdermal PM, or if you're able to wear seatbelts as you did before you got wired, let me know.

Have a wonderful day.


9 Comments

Good tune!

by Persephone - 2021-08-25 17:38:21

...I've just recently learned that one on the bass (with slightly different lyrics :).  I think with subQ, while it's not fair to call it a crapshoot, you may not have control over where it actually gets placed and what that will mean to you.  Mine is kind of high center left, just below the clavicle, which bugs me for clothing choices, but works for the bass strap.  This is just what I wound up with as I didn't know what to ask before it went in.  Car seat belts are an easy fix with a cover, so not a big deal and just one of the details.  Great that you have time to consider your options.

Sub-pec

by AgentX86 - 2021-08-25 19:33:35

If you're that thin, it might be a good idea, particularly if you're worried about looks. I'm 5'10 and about 200lbs. My pacemaker, though it's a CRT-P (somewhat larger than a "normal" pacemaker) is clearly visible, as are the leads comming out of it going up towards clavicle.

I know nothing of playing a guitar but that would be a comcern for me.  Good thinking. A shoulder harness isn't a problem at all. One of the dirt-cheap sheep skin (either real or faux) belt covers work perfectly. Slide it onto the strap and position it to the right of your pacemaker, over the sternum. This will lift the strap over the pacemaker and your problem is solved. I've been using one for three plus years.

Don't worry about it in an accident, either. I was just in a high-speed collision to the starbird bow. Busted up an arm pretty badly but didn't even notice any hit to my PM. I was taken to the ER to check everything out, including a CAT-A looking for brain bleeds (anticoagulant) but not even a twinge from my PM pocket. I'm sure the air-bags helped.

The same strategy might work for a guitar strap, as well. You could try it now.  See if there is a space between the chest and the strap. Maybe add a shoulder pad to help lift it.

I don't know why a seb-pec would move more than a sub-q either. I'd think (but don't know) that it would be easier to anchor a sub-pec PM.

Sub-pec

by ar_vin - 2021-08-25 19:36:33

First ask the EP how many sub-pec implants he has done and how often he does them.

It's possible he simply does not have much experience with sub-pec implants. I'd suggest seeking out an EP who does sub-pec implants regularly and has done many.

Sub-pec implants are not at all uncommon; your physician's hesitation suggests he's just not comfortable doing the procedure.

I asked my EP for a sub-pec implant and he readily agreed to it. And I'm pretty skinny (under 140 lbs).

I had significant pain the night after the procedure once the local anaesthetic wore off. But I managed with an ice pack and no oral pain medication. In fact I didn't take any pain medication after the procedure.

The pain got better after the second or third day. The good part was that the surgical wound was sealed with glue so I could shower the day after my procedure. 

A daily shower and regular walks helped with the healing and with pain.

This was my only PM implant so I have nothing to compare it with.

I do a lot of outdoor activities: hiking, running, backpacking, cycling, climbing etc. and I often carry a backpack. Having a sub-dermal implant would not be comfortable!

Less than a year later I didn't know I had a PM. Of course I had my settings tweaked about 4-6 months after my implant.

You are doing the right thing by asking for a sub-pec implant; I sure wouldn't do it any other way.

 

 

 

 

subpec

by Tracey_E - 2021-08-26 09:28:26

I agree with ar-vin, it sounds like your ep doesn't do subpec very often. My surgeon didn't either, so he brought in a plastic surgeon to assist. Easiest job of the day for the plastic surgeon, an my ep could stick with what he's comfortable with. 

Grateful

by Runner86 - 2021-08-26 10:41:48

I am very grateful for the comments and advice!

It does sound like the surgeon matters a *lot*, @ar_vin are you saying you're able to carry your backpack directly over your subpec PM? That's what I'm praying for, to be able to use a guitar strap over my PM, since the muscle is cushioning it naturally. Maybe I'm being too optimistic...

"Didn't know I had a PM" is my goal and I'm just nervous about the procedure going sideways... I know statistically speaking it is a safe procedure but that doesn't take into account the ability to sleep/exercise/jam... worried about choosing the right doc to do the initial implant.

I know it's supposed to be longer recovery for battery swaps, but I feel like it would be worth it to get it buried and placed in a nice place. I don't want to roll the dice on a leadless, I don't think. Hard days ahead.

Thanks again for the replies.

 

Sub-pec

by ar_vin - 2021-08-26 13:12:18

Yes I carry my small running pack and my backpacking pack with the straps over the PM  area.

Most of the time I don't feel any discomfort except while running downhill on longer runs (10+ miles). The pack tends to bounce around a bit leading to some rubbing and discomfort. I'm careful to cinch the running pack straps and that helps.

I almost feel nothing while backpacking - I've carried up to 45 lbs on longer trips. It's mostly food weight which tends to go down as the days go by.

I don't know what the the PM replacement will feel like when the time comes but I like how my PM is out of the way under muscle.

Find an EP you can work with.

 

replacement

by Tracey_E - 2021-08-26 15:51:55

I'm on #5. Replacement when it's buried leaves me a little more sore than someone with subdermal, but it's not bad at all. If I get an early appointment,I'm home fixing my own lunch and answering work emails that afternoon. I get by on ice packs and tylenol. This last time I was out of the gym for 4 weeks, not because I was sore but because my doctor said getting all sweaty before the incision was fully healed increased infection risk. I think that was overkill, but it didn't kill me to take the time off. 

Runner86

by Ram - 2021-08-27 14:24:27

You might want to check with your EP if you are a good candidate for the Micra AV pacemaker.  Google it at the Medtronic website.  You have to have a normal sinus node rhythem.  Also have good insurance as it is probably more expensive.  I too was asymptomatic with AV block.  There are a lot of people in this club that don't agree that it is a good choice being fairly new but I have an excellent doctor, head of the device dept. at a major cardiac center who thought it was a great choice for me.

Subpec vs Subderm

by Kpflma - 2021-09-16 12:06:52

Hi there, I wasn't aware of this issue and that's probably because I have sick sinus node syndrome, so that wouldn't be an option. However I just wanted to add that if you do have to have the subdermal for whatever reason, I've done fine with all that. I'm small, 5'4 and I range between 110 lb and 135 lb. Like a lot of women,  I don't have much upper chest muscle. I haven't had any problems with those things you mentioned. It's true that I don't play guitar. However I backpack quite frequently and of course drive and actually I always carry my purse on my right side which is the same side as my pacemaker. Occasionally, that area feels a little sensitive, But that is rare. I received my first pacemaker when I was 41 and I was dating, I had just gotten divorced. So I was a little sensitive about how it looked, as I would often wear tops that would reveal it. Over time, I got used to it and I realized that no one else really seemed to notice. I literally have never had anyone ask me about it due to sight alone. Also, this third one is smaller and I'm hoping once The incision heals that the profile will be much lower. So I hope that helps! However it sounds like you're going to go for the subpectoral, which sounds like a good choice. Oh also, perhaps you can request to have it implanted on the opposite side of where you wear your guitar strap? Also, I think the most important thing to consider is having an excellent surgeon because you want those leads well placed. Good luck with the procedure and recovery, Kathy

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