Transaxillary Subpectoral Placement of Cardiac Implantable Electronic Devices in Young Female Patients

 

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Background The current indications of cardiac implantable electronic devices (CIEDs) have expanded to include young patients with serious cardiac risk factors, but CIED placement has the disadvantage of involving unsightly scarring and bulging of the chest wall. A collaborative team of cardiologists and plastic surgeons developed a technique for the subpectoral placement of CIEDs in young female patients via a transaxillary approach.

Methods From July 2012 to December 2015, subpectoral CIED placement via an axillary incision was performed in 10 young female patients, with a mean age of 25.9 years and mean body mass index of 20.1 kg/m2. In the supine position, with the patient's shoulder abducted, an approximately 5-cm linear incision was made along one of the deepest axillary creases. The submuscular plane was identified at the lateral border of the pectoralis major, and the dissection continued over the clavipectoral fascia until the subpectoral pocket could securely receive a pulse generator. Slight upward dissection also exposed an entrance to the subclavian vein, allowing the cardiology team to gain access to the vein. One patient with dilated cardiomyopathy underwent augmentation mammoplasty and CIED insertion simultaneously.

Results One case of late-onset device infection occurred. All patients were highly satisfied with the results and reported that they would recommend the procedure to others.

Conclusions With superior aesthetic outcomes compared to conventional methods, the subpectoral placement of CIEDs via a transaxillary approach is an effective, single-incision method to hide operative scarring and minimize bulging of the device, and is particularly beneficial for young female or lean patients.

This study was presented at the Sixth Research and Reconstructive Forum of the Korean Society of Plastic Surgeons on April 7th, 2016 in Daegu, Korea.

Publication History

Received: 22 April 2016

Accepted: 19 October 2016

Article published online:
20 April 2022

© 2017. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

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• REFERENCES

• 1 Connolly SJ, Hallstrom AP, Cappato R. et al. Meta-analysis of the implantable cardioverter defibrillator secondary prevention trials: AVID, CASH and CIDS studies. Antiarrhythmics vs Implantable Defibrillator study. Cardiac Arrest Study Hamburg Canadian Implantable Defibrillator Study. Eur Heart J 2000; 21: 2071-2078
  CrossrefPubMedGoogle Scholar
• 2 Goldberger Z, Lampert R. Implantable cardioverter-defibrillators: expanding indications and technologies. JAMA 2006; 295: 809-818
  CrossrefPubMedGoogle Scholar
• 3 Hammill SC, Kremers MS, Stevenson LW. et al. Review of the registry’s fourth year, incorporating lead data and pediatric ICD procedures, and use as a national performance measure. Heart Rhythm 2010; 7: 1340-1345
  CrossrefPubMedGoogle Scholar
• 4 Vazquez LD, Kuhl EA, Shea JB. et al. Age-specific differences in women with implantable cardioverter defibrillators: an international multi center study. Pacing Clin Electrophysiol 2008; 31: 1528-1534
  CrossrefPubMedGoogle Scholar
• 5 A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias: the Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators. N Engl J Med 1997; 337: 1576-1583
  CrossrefPubMedGoogle Scholar
• 6 Sears Jr SF, Todaro JF, Lewis TS. et al. Examining the psychosocial impact of implantable cardioverter defibrillators: a literature review. Clin Cardiol 1999; 22: 481-489
  CrossrefPubMedGoogle Scholar
• 7 Thomas SA, Friedmann E, Kao CW. et al. Quality of life and psychological status of patients with implantable cardioverter defibrillators. Am J Crit Care 2006; 15: 389-398
  CrossrefPubMedGoogle Scholar
• 8 Marshall P, Ketchell A, Maclean J. Comparison of male and female psychological outcomes related to implantable cardioverter defibrillators (COMFORTID). Eur J Cardiovasc Nurs 2012; 11: 313-321
  CrossrefPubMedGoogle Scholar
• 9 Belott PH, Bucko D. Inframammary pulse generator placement for maximizing cosmetic effect. Pacing Clin Electrophysiol 1983; 6: 1241-1244
  CrossrefPubMedGoogle Scholar
• 10 Allan D. Augmentation mammaplasty approach to pacemaker implantation. Ann Plast Surg 1985; 15: 242-243
  CrossrefPubMedGoogle Scholar
• 11 Kolettis TM, Saxena A, Krol RB. et al. Submammary implantation of a cardioverter-defibrillator with nonthoracotomy lead system. Am Heart J 1993; 126: 1222-1223
  CrossrefPubMedGoogle Scholar
• 12 Ozin B, Borman H, Bozbas H. et al. Implantation of submammary implantable cardioverter defibrillators. Pacing Clin Electrophysiol 2004; 27: 779-782
  CrossrefPubMedGoogle Scholar
• 13 Schaverien MV, Elder D, Munnoch DA. Inframammary cardiac pacemaker insertion in women: an aesthetic alternative. Plast Reconstr Surg 2013; 131: 464e-465e
  CrossrefPubMedGoogle Scholar
• 14 Giudici MC. Experience with a cosmetic approach to device implantation. Pacing Clin Electrophysiol 2001; 24: 1679-1680
  CrossrefPubMedGoogle Scholar
• 15 Giudici MC, Carlson JI, Krupa RK. et al. Submammary pacemakers and ICDs in women: long-term follow-up and patient satisfaction. Pacing Clin Electrophysiol 2010; 33: 1373-1375
  CrossrefPubMedGoogle Scholar
• 16 Persichetti P, Brunetti B, Cagli B. et al. Aesthetic subpectoral placement of implantable cardioverter defibrillators. Ann Plast Surg 2014; 72: 188-192
  CrossrefPubMedGoogle Scholar
• 17 Hammel D, Block M, Borggrefe M. et al. Implantation of a cardioverter/defibrillator in the subpectoral region combined with a nonthoracotomy lead system. Pacing Clin Electrophysiol 1992; 15: 367-368
  CrossrefPubMedGoogle Scholar
• 18 Asamura S, Kurita T, Motoki K. et al. Efficacy and feasibility of the submuscular implantation technique for an implantable cardiac electrical device. Eplasty 2014; 14: e40
  PubMedGoogle Scholar
• 19 Molina JE. New technique for pacemaker implantation in the upper chest of children and women. Ann Thorac Surg 1991; 51: 992-995
  CrossrefPubMedGoogle Scholar
• 20 Shefer A, Lewis BS, Gang ES. The retropectoral transaxillary permanent pacemaker: description of a technique for percutaneous implantation of an “invisible” device. Pacing Clin Electrophysiol 1996; 19: 1646-1651
  CrossrefPubMedGoogle Scholar
• 21 Rosenthal E. A cosmetic approach for pectoral pacemaker implantation in young girls. Pacing Clin Electrophysiol 2000; 23: 1397-1400
  CrossrefPubMedGoogle Scholar