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A Cosmetic Approach for Pectoral Pacemaker Implantation in Young Girls
Author(s) -
ROSENTHAL ERIC
Publication year - 2000
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2000.tb00969.x
Subject(s) - medicine , pectoralis major muscle , surgery , pectoralis muscle , pectoral muscle , axillary vein , axilla , axillary lines , scars , anatomy , thrombosis , cancer , breast cancer
Pectoral placement of pacemaker generators, combined with use of a redundant intravascular lead portion, reduces the need for endocardial lead advancement during growth in children. While the use of small generators and submuscular pockets has contributed to cosmetic acceptability, the conventional subclavicular incision may occasionally form a keloid scar that is unacceptable in young girls. A modified implantation technique was used in five girls (age 2.6–13.3 years) during implantation of VDD (n = 2), VVIR (n = 2), and DDDR (n = 1) pacemakers. A 5‐cm incision was made in the axilla along the line of the pec‐toralis major and dissection was continued below the muscle to create a pocket for the generator. Subclavian vein puncture was performed from the axillary incision and beneath the pectoralis major muscle using standard or extra long needles with a needle guard. Peel away sheaths were used for lead positioning. The generator was placed in the submuscular pocket and the wound closed with absorbable sutures. At follow‐up, pacemaker function was excellent and neither the scars nor pacemakers were visible from the front. In conclusion, the axillary incision with direct subclavian vein puncture from below the pectoralis major muscle offers the advantages of pectoral pacemaker implantation through a single cosmetic incision.