Subcutaneous Tethering

Sub-cutaneous is the normal position

by crustyg - 2023-09-12 05:38:06

Apart from those who specifically request a sub-pectoral placement, the normal place for the device pocket is sub-cutaneous on the L-upper chest.

I can clearly see the outline of my PM, I can see and, perhaps with the eye-of-faith, see the dents where the leads connect to it, and despite a good anchor stitch I can tilt the device up to show interested people the device.  Yes, I know, weird show-off.

One of the regular checks at in-person reviews is to ensure that the connections aren't erodiing through the skin from underneath.

There's no doubt that a sharp blow over the lead-connector area will hurt a lot more than the same intensity of impact over any other chest area.

There are businesses who advertise here - and who help pay for this site - who will sell you protection devices against exactly that sort of impact.

Best wishes.

pacemaker positioning

by yotboy - 2023-09-12 07:34:12

Thanks - sounds like mine. My first and second one's were placed under the muscle entirely.  I'm wondering how many come through the skin, if any.

I've had a quick look at the protective stiff and remembered I have a shed full of various densities of foam already handy at home - free.

Skin erosion with pacemakers

by Selwyn - 2023-09-12 14:38:35

Skin erosion is rare and usually the result of a fail person, infection, blood clot formation etc.

My pacemaker is subcutaneous, very visible, even the leads are visible and only of concern if I am wearing my rucksack ( the straps rub). The  lateral edge sticks out and is quite sharp. I am just keeping an eye on it. My first pacemaker was better placed. 

To answer your question: Skin erosion is caused by the pacemaker generator, and is usually a result of pocket infection. Other precipitating factors can be present, for example, the extremely fragile skin of elderly patients, a pocket that is too small, precarious subcutaneous fat, chronic use of corticoids, and use of abrasive disinfectants (Kiviniemi et al., 1999). Exteriorisation of a generator, and/or a lead, is always associated with bacterial contamination, making removal of the material an obligation, accompanied by antibiotherapy and eventually re-implantation on the contra-lateral side. Skin erosion is hence to be sort for and detected before exteriorisation. This is rarely an early complication, and incidence is estimated to be 1%. 

( of course this means nothing if you are in the 1%, otherwise be reassured.) Don't fiddle with it as this worsens the problem.

Skin erosion -pacemaker

by yotboy - 2023-09-12 15:20:59

Thankyou -helpful and reassuring. I'm male 78, healthy and fit. I have to care particularly for lower leg dry skin  and am ever watchful.

I don't remember ever being in the 1% of anything, so I'll hope that continues.

Many thanks

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