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The author reports no conflicts of interest for the published content. Address correspondence to: Arash Aryana, MD, PhD, FHRS, Mercy General Hospital and Dignity Health Heart and Vascular Institute, 3941 J Street, Suite #350, Sacramento, CA 95819, USA. Email: a_aryana@outlook.com. In this month’s issue of The Journal of Innovations in Cardiac Rhythm Management, Kloosterman et al.1 report on the use of the axillary fossa as an alternate site for the implantation of cardiovascular implantable electronic devices (CIEDs). The authors report their experience using this approach in a cohort of five individuals consisting largely of elderly, emaciated patients with significant thinning of the musculocutaneous tissue, including two patients undergoing a pacemaker generator replacement, two patients receiving de novo pacemaker implants, and one patient undergoing a cardiac resynchronization therapy defibrillator generator replacement. Briefly, this interesting technique involves establishing venous access using the conventional approach. Subsequently, the lead(s) are tunneled and connected to the generator, which is implanted in a pocket created within the axillary fossa. Based on the authors’ experience, all five implants yielded favorable outcomes with the exception of a case of transient postoperative numbness in the ipsilateral arm with no pain or functional mobility impairment that eventually resolved without intervention.

In Search of Alternate Implantation Sites for Pacemakers and Defibrillators: Pacing Along Creativity and Innovation