Round 5 - Submuscular Implant Time

• by CRT-D Marine
• 2017-04-17 12:32:02
• ICDs
• 1683 views
• 2 comments

Hey all:

First, many thanks to memebrs and posters on this site for great information and your transparency.  It's nice to find a comunity of similarly situated individuals to open up to and share experiences. I'm undergoing another procedure a few days after the six month mark on my fourth surgery.  I'm new to the site and glad I found it.

Brief History (aka long story short):

Had my aortic valve replaced when I was a 20 year old Corporal in the Marine Corps (Oct. 1998).  One month later had my first pacemaker implanted.  My heart had enlarged three times its normal size (Grinch in reverse) and after the valve replacement I never regained proper heart function (the two chambers weren't communicating properly - heart sinus issue determined as cause).

In August of 1999 I was diagnosed with Conghestive Heart Failure - Ejection Fraction (EF) of appx. 28%.  I spent the next couple of years in a self-induced drug and alcohol haze (amazingly carring a 3.8 GPA in college).  After a lot of soul searching and acceptance (I'll be happy to share that in more detail if anyone is interested), I got married and went to grad school.  In 2005 my ejection fraction had dropped to 15% - and I could tell.  As my pacemaker was in need of replacement, my cardiac team at the Veterans Affairs hospital received and obained permission to implant an CRT-D.  I am a patient and work for the VA - I have a great deal of confidence in our cardiac unit.

After the surgery I immediately felt better.  Followup echo at four months out showed my EF at 48%.  It has held that steadily since then.  Graduated with my MBA, became a father, got a job.  Had the device replaced in 2010 (recalled lead removed and replaced by the cardiologist that helped pioneer the procedure).  EF still rocking and rolling!  In October of 2016 I learned my CRT (St. Jude) was recalled.  Had it replaced with a Medtronic Viva S CRT-D. 

I felt awful after that.  I kept going in and letting my team (who had treated me since 1999) know something was off.  I just felt weak and dizzy all the time.  Luckily, at the six month mark (last week) a manual transmission showed a problem with the settings.  The device sensitivity was counting heartbeats twice and underpacing.  Went in and had changes made - I'm back baby!!  I feel great again.

There is an issue though.  This new device is larger than my last.  All of my previous implants have been subcutaneous.  This new device has been sore to the touch since it was implanted - my 18 month old daughter likes to grab it too. :(  Had the cardiologist take a look and he recommended I have the device reseated submuscular. 

Possible issues are the device eroding the skin and/or breaking through the skin. Neither of which are pleasant outcomes.  Eroding of the skin may allow infection to easily set in.  the device breaking through the skin - well that would just suck.  So, submuscular it is.  Surgery is planned for the end of next week (April 28).

I've read a lot of the forums on here regarding submuscular implantation and recovery.  Although there's a lot of good information on here, I'm a details person and looking for more.  So, I'm going to post my recovery on here and compare and contrast subcutaneous vs submuscular implant and recovery - obvioulsy from my point of view as each of us will have differing experiences.

As with any procedure, I'm nervous, but ultimately know I am not in control and there is a bigger plan in place of which I play only a small part.  I'm not looking forward to going under general anesthesia, but it is what it is.  I'll keep everyone here posted.

Again, thanks for the information I've read on this site and the site itself.  In the words of the great Paul Harvey, "Stand by for news!!"