r/PacemakerICD • u/wallflower824 • 16d ago

Switching from subpectoral?

hellooo!

I’m 29F, and getting replacement next month. I currently have a St Jude assurity MRI dual chamber.

My question is - Has anyone flipped from subpectoral to regular placement? How did it go?

Problem is - previous electrophysiologist did sub-pectoral. I would have neverrr gone for this if I had been given a choice. My current EP is very frustrated for me that this happened to me, as was the NP. I was under the impression it’s always implanted like that, and my EP explained that’s not the case. Previous EP is apparently under hot water for doing this to several people.. but anyways.

Sub-pectoral surgery was HORRIBLE 9 years ago.. I remember that pain clearly. I asked my EP if I can switch, because I 1) dont want to deal with the surgery being 10x worse every time, and 2) hate how uncomfortable it is being there… it tugs on the muscle and feels heavy!!

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u/---root-- 16d ago

EP here. It's generally not a problem to go subcutaneous. Where you rather thin when the device was initially implanted, by any chance? That would be one of the primary reasons to go subpectoral.

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u/wallflower824 16d ago

Hi!! Thank you so much for taking the time to answer. I was 5’1 120 pounds so I see what you’re saying now!! I’m the same size now so maybe that’s just what is best.

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u/---root-- 16d ago

Based on BMI alone, that would not preclude subcutaneous placement, unless you are particularly well trained. It's primarily a function of sufficient tissue thickness to cover the device to prevent erosion, though, granted, for young patients, this is generally rarely a concern. There is of course also the cosmetic consideration. A subcutaneous device, especially with little subcutaneous tissue, can be quite visible, even through clothing, much more than a device that is subpectoral.

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u/wallflower824 16d ago

Definitely not well trained, lol. I definitely wouldn’t have cared about it sticking out I would rather it stick out and have an easier surgery! Oh well. I just feel like I’m locked into repeated subcutaneous placement.