ABSTRACT
BACKGROUND: Device placement in women has unique considerations not addressed with standard implant techniques. These may include irritation and discomfort from purse and/or bra straps, changes in body image, and cosmetic issues with visible scars. Submammary device placement (SMI) addresses these problems and may be associated with greater patient comfort, cosmesis, and device acceptance. METHODS AND RESULTS: Over a 9-year period, 51 women, mean age 47 years (range 13-70 years), underwent submammary device implantation at our institution. These included seven cardiac resynchronization therapy devices, 26 implantable cardioverter defibrillators, and 18 pacemakers. Devices had been implanted for a mean of 57 months (range 2-118 months) when, in 2009, patient satisfaction was assessed via a telephone survey. Questions related to the initial decision, the preprocedure education, implant experience, recovery, complications, and long-term satisfaction. Seventy-three percent of women listed cosmesis as their main reason for SMI, 76% had a mammogram since implant, and 89% reported no issues with mammography. Ninety-seven percent felt that SMI was the right choice and 95% stated they would do SMI again. Ninety-five percent also said they would recommend the procedure to others. CONCLUSION: Complications were rare (three lead dislodgements and one pneumothorax). SMI has high patient acceptance and long-term satisfaction with few complications. This procedure should be considered in women requiring device implantation.
Subject(s)
Defibrillators, Implantable/psychology , Mammary Glands, Human , Pacemaker, Artificial/psychology , Patient Satisfaction , Adolescent , Adult , Aged , Body Image , Cicatrix/psychology , Female , Follow-Up Studies , Humans , Mammography , Middle Aged , Patient Acceptance of Health Care/psychology , Postoperative Complications/psychology , Prosthesis Implantation/methods , Prosthesis Implantation/psychology , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
BACKGROUND: The electrocardiogram (ECG) patterns during pacing from the great cardiac vein (GCV) and the middle cardiac vein (MCV) are not well known. METHODS: We recorded 12-lead ECGs during GCV and MCV pacing in 26 patients undergoing implantation of a cardiac resynchronization device. The left ventricular (LV) lead was passed down the GCV (n = 19) or MCV (n = 7) prior to moving it to a lateral or posterolateral vein for permanent implantation. RESULTS AND CONCLUSIONS: Pacing within the GCV resulted in a left bundle branch block (LBBB) morphology with no or minimal R-wave in V(1) in 14 patients and a right bundle branch block (RBBB) pattern (R > S in lead V(1)) in four patients. In one patient, lead V1 during GCV pacing was isoelectric (R = S). A more distal pacing site in the GCV yielded a LBBB pattern in all the patients. All leads placed in the MCV resulted in a LBBB configuration. An ECG pattern with a RBBB pattern was invariably recorded during LV pacing in 125 consecutive outpatients with biventricular pacemakers and LV leads in the posterolatral and lateral coronary veins. Knowledge of the ECG patterns from various pacing sites in the coronary venous system may be helpful for troubleshooting all types of pacing systems, especially those where the coronary venous pacing site is unintentional.
