How to Make a Submuscular Pocket

  title={How to Make a Submuscular Pocket},
  author={Rafael E. Pe{\~n}a and Richard K. Shepard and Kenneth A. Ellenbogen},
  journal={Journal of Cardiovascular Electrophysiology},
Today, most devices are placed in the prepectoral location in a procedure that has evolved to become safe, fast, and routine. However, at times patients will be encountered who require placement of a pulse generator below the muscle. Such patients may be identified by a low body mass index, depleted fat stores, and lack of adequate subcutaneous tissue to adequately cover the device. These patients are at high risk for device erosion. Another candidate for submusclar device placement would be a… 
Reimplantation of a Pacemaker into a Subpectoral Pocket Via the Lateral Approach in Collaboration with Plastic Surgeons
This case showed that creating a subpectoral pocket in collaboration with plastic surgeons is quick and safe and unable to implant leadless pacemakers at their hospital due to lack of sufficient skill.
Transvenous pacing in pediatric patients with bipolar lumenless lead: Ten-year clinical experience.
In a pediatric population, the Select Secure™ lead used in the axillary vein, the creation of an intra-atrial loop and the placement of the generator in a sub-pectoral pocket ensured a safe implantation of pacemaker or ICD and an effective stimulation at medium-term follow-up.
Implantation of the Subcutaneous Implantable Cardioverter-Defibrillator: An Evaluation of 4 Implantation Techniques
The presented implantation techniques are feasible alternatives to the standard 3-incision subcutaneous implantation, and the 2- incision technique resulted in shortest procedure duration and time-to-hospital discharge compared with the other techniques.
A simple technique for relocating chronic CIED leads to a subpectoral position for relief of erosion and pain
  • A. Hesselson
  • Medicine
    Pacing and clinical electrophysiology : PACE
  • 2018
Relocation of prepectoral leads and generator to a submuscular pocket for relief of erosion and pain with minimal pectoral trauma is possible by applying a variant of a previously described submammary tunneling technique.
Analysis of Pacing and Defibrillation Lead Malfunction
Lead malfunction includes damage to biologic tissues (tricuspid stenosis or regurgitation, cardiac perforation, pericardial effusion without perforations), and lead design should allow for extractability as well as reliability.


The Subpectoral Pacemaker Implant:
A subpectoral pocket approach is described, which on anatomic investigation is actually “intrapectoral” and offers a much improved cosmetic result with the potential advantage of less erosion.
Pectoral Cardioverter Defibrillators: Comparison of Prepectoral and Submuscular Implantation Techniques
For exclusive pectoral implantation of transvenous ICDs, electrophysiologists should master both prepectoral and submuscular techniques to avoid potential skin erosion or need for abdominal implantation in patients with a thin layer of subcutaneous tissue.
The subpectoral pacemaker implant: It isn’t what it seems! Pacing Clin Electrophysiol 2004;27:361-364
  • 2004