Reimplantation of a Pacemaker into a Subpectoral Pocket Via the Lateral Approach in Collaboration with Plastic Surgeons

Abstract

An 86-year-old woman had a pacemaker implanted into a subfascial pocket. After four months, the generator became exposed, and the pacemaker was removed. She exhibited a lack of prepectoral tissue. We therefore performed reimplantation in collaboration with plastic surgeons. We placed the leads via the extrathoracic subclavian venous approach, and plastic surgeons created a subpectoral pocket from the low lateral side of the pectoralis major muscle. General cardiologists rarely create subpectoral pockets and they are unable to implant leadless pacemakers at their hospital due to lack of sufficient skill. Our case showed that creating a subpectoral pocket in collaboration with plastic surgeons is quick and safe.

Alternative Implantation Site of Intrathecal Pump in the Submuscular Plane of the Pectoralis Major Muscle: A Case Report

“…Other devices within the field of neuromodulation, such as vagus nerve and deep brain stimulators, 6,7 have adopted this location in select patients when conventional placement is not feasible. Outside of the field of neuromodulation, the subpectoral region has been utilized by cardiology with the placement of cardiovascular implantable electronic devices (CIEDs), 8 and commonly by plastic surgery for breast implantation.…”

Widening the scope of complex cardiac implantable electronic devices implant considerations: Time for an integrated multidisciplinary approach

“…It is not new that plastic surgeons have gotten involved in CIEDs implants, as a matter of fact the concepts of subglandular, subpectoral, and transaxillary subpectoral placement have been described in plastic surgery journals 6‐9 . Also it has been described before collaboration of cardiologists and plastic surgeons in dealing with CIED implants 10 …”

“…It is not new that plastic surgeons have gotten involved in CIEDs implants, as a matter of fact the concepts of subglandular, subpectoral, and transaxillary subpectoral placement have been described in plastic surgery journals. [6][7][8][9] Also it has been described before collaboration of cardiologists and plastic surgeons in dealing with CIED implants. 10 The authors however present the experience of electrophysiologists collaborating in a systematic (not casual) way with plastic surgeons in a series of 22 consecutive cases over 7 years.…”