Reposition of Cardiac Implantable Electronic Devices Using Pectoralis Major Muscle Pocket

Yoon, Hyun Sik; Na, Young Cheon

Abstract

Increasing implantations of cardiac implantable electronic devices mean that complications such as infections and device exposures have also surged. A 66-year-old man visited our clinic with recurring cardiac device exposure due to skin defects. He had undergone pacemaker insertion by a cardiologist 7 years earlier, and after experiencing device exposure, had had two revision operations, 1 year ago and then again 3 months prior. The patient's pacemaker function test results and laboratory findings were normal and the clinical signs convinced us that his condition was a non-infectious reaction. We therefore repositioned the device to a different plane. With minimal dissection, we created in the shape of a reverse trapezoid a specific pocket slightly smaller than the device to reposition the device under the pectoralis major muscle. The patient recovered without complications. Though principle dictates that an exposed device should be removed and re-implanted in a new site, conservative treatment is attempted in some cases because of the high cost, potential for complications during removal, and specific circumstances of the patient. Repositioning the device to change the plane using a specific pectoralis major pocket can serve as an option for certain cases.