ICD Question - Sub Q, Sub Pectoral, etc.

Hi all,

I'm 24 years old, male, and was recently diagnosed with hypertrophic cardiomyopathy after my older brother was hospitalized from fainting, and received an ICD himself.

He barely qualified for the Subcutaneous ICD from Boston Scientific - and I did NOT qualify for that device due to T-Wave oversensing. My EP and the Boston Scientific rep. both told me that I would be unable to receive the newer device at this time due to the possibility of the algorithms incorrectly identifying my normal heartbeat as a life-threatening arrhythmia.

I have an appointment this week to receive a traditional, transvenous ICD. I asked my EP about doing the installation under my pectoral muscle, and he suggested that not many people did that anymore - that he personally hasn't in years - and that the cosmetic difference is often negligible.

I'm not particularly concerned with how it looks, but I am a pretty skinny dude. With the most recent ICDs, is just below the skin going to be that much more noticeable than under the muscle? I have to consider that I'm young and changing the battery / leads is going to be a bigger hassle if it's under the muscle. 

I'm mostly asking because there are a surprisingly low amount of any sort of pictures or visual comparisons online..

Thank you
C

3 Comments

subpec

by Tracey_E - 2017-02-22 12:38:12

Mine have all been pacemakers, not icd which are larger, but all 5 have been subpec and I was very underweight when I got my first one. Yes, it makes replacement a bit harder but it's not that bad, just a little more soreness after.

I would disagree that the difference in how it looks is neglegible. Too look at me, you'd never know I have it. I do crossfit and kayak and hike with a heavy backpack, it never gets in the way. Sometimes they can do it lower and deeper without going under the pectoral and it ends up looking and feeling better than when they put it just under the collarbone without going to the trouble of putting it under the muscle. It all depends on your build and the size of the device. Perhaps consult with a plastic surgeon? 

I'm no professional, just someone who has been paced a long time, asks a lot of questions and talks to a lot of people, but I think burying it is much more common now than it used to be, not less common. When I got my first one in 1994, alternate placement was virtually unheard of and my doctor was more or less making it up as he went along so he brought in a plastic surgeon to assist. JMHO, but it sounds like your doctor just doesn't want to mess with it. Some don't, they want to keep it simple, and that's ok,but that may not be the right doctor for you. Don't be shy about getting another opinion or being more forceful to make it clear you want it out of the way. 

Good luck!

SICD and defibs

by belsheart - 2017-03-08 02:02:46

I didn't have a good experience with the SICD.  I just had a"regular" defibrillator put in because I also needed pacing due to a host of heart issues, such as chronotopic incompetence.  In removing the SICD, the EP doc told me that it was situated deep in the muscle, which, he said, explained the pain Iexperienced.  Unless you really, really care about an outline of the ICD showing, I would advise just getting it done the typical way.  I come from a persepctive in which how something looks just isn't the most important thing.  Without going into too many details, I have a child (now grown) who is a severe burn survivor and he has taught me a whole, whole lot about what matters.  An ICD showing just isn't a big deal, in my humble opinion.  What is important is that you are getting this lifesaving device.  I hope you get it in soon, recover easily, and then have many, many, many years of joy.

crt-d sub on right side

by BOBJ - 2017-03-31 15:37:25

My first was left side subcute - infected - removed - .

Due to skin issue and delayed healing reimplant was placed on right and under muscle.

1 - More soreness but for shorter time

2 - more movement sooner

3 - less chance of device infection

4 - more expensive

5 - harder to place leads although my leads should be fine for next replacement

6 - a little harder to replace battery

My first was told 6-8 weeks before my restrictions would be lifted.

This device - fully healed - leads implanted - and no restrictions at exactly 1 month post op.

Also too the device I listed is larger than an icd since mine is a biventricular pacer and icd

 

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