Subcutaneous Tethering

About 50% of my pacemaker is under the skin as opposed to under the muscle. An area of about 1" x1" has become permanently tethered to the skin. Hospital says the risks involved in reseating the device make it preferabl to leave it as it is. Occasionally the area gets bruised if I'm un lucky enough to knock it on something. Any bruising disappears after a few days.

I'd welcome any comments from others with this condition with regard to the longer term safety.


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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