subpec vs. subcutaneous - again

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NotinSF
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subpec vs. subcutaneous - again

Post by NotinSF » December 28th, 2012, 4:11 pm

Hi All,

I know this topic has been discussed before but I've read through all the threads and I'm still really confused as to what to do.

I'm scheduled to get my first ICD in 2 weeks. I've spoken with a few people I trust who have said to me - "Definitely get it under your skin. You don't want to mess with cutting into muscle if you don't have to. It takes longer to heal. Why make things more complicated than they need to be?" I can understand that point of view.

And yet, there seem to be many people on this board who insist that a submuscular implant is better. They say it looks better, it feels better, you don't have the constant reminder of the ICD, etc. I've also read the complaints about subcutaneous implants about the ICD moving around in the pocket, the wires 'poking' out, being really sensitive, etc.

I spoke with the EP and he's willing to do it either way.

I'm willing to put up with a slightly longer recovery if I need to.

How often do problems with subcutaneous implants really occur?

It seems that the large majority of people get it done this way and don't seem to complain so much about it....?

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mrag
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Re: subpec vs. subcutaneous - again

Post by mrag » December 28th, 2012, 4:39 pm

It might help if we knew if you were male, female, skinny, not skinny or really not skinny, young, old or ancient, active, passive or plant like. I can see a discussion with your doctor about a preferred icd manufacturer, but as for placement, hopefully he/she could provide some clear reasoning on where they will place the thing.

Are you into topless? If not, simple is better IMHO.
"The greatest enemy of knowledge is not ignorance, it is the illusion of knowledge" S Hawking

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NotinSF
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Re: subpec vs. subcutaneous - again

Post by NotinSF » December 28th, 2012, 4:55 pm

mrag wrote:It might help if we knew if you were male, female, skinny, not skinny or really not skinny, young, old or ancient, active, passive or plant like. I can see a discussion with your doctor about a preferred icd manufacturer, but as for placement, hopefully he/she could provide some clear reasoning on where they will place the thing.

Are you into topless? If not, simple is better IMHO.
I'm male, 40, about 6 feet tall, thin, and active. I'm more likely to be mistaken for a runner than a weightlifter. The EP showed me where it would go - on my left side closer to my shoulder than my collarbone.

I'm a fan of topless women but don't tend to go around without a shirt that often unless on the beach in summer. ;)

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mrag
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Re: subpec vs. subcutaneous - again

Post by mrag » December 28th, 2012, 5:13 pm

Glad to meet you, I'm a fan too ;-) Chicks like scars and you're going to have a scar regardless. They also like bulges or so I was told one time. My feeling (intuition?) is simply under the skin is safer, faster, easier. How about replacement-in 6 years or so you will need to have the thing changed. What is the deal with that-which is easier to replace? Check out JR1966's recent post on having his ICD replaced and what YOUR doctor might think better for you in the future to possibly avoid such a nightmare.

I will get in trouble for this, but either way is uninteresting to me. Totally your call. If it was me, I'd say put it anywhere you like, but I want a Medtronic. I have now had two Boston Scientifics that have worked quite fine. But there is only one manufacturer I've seen continually on this forum and that to me is a much bigger plus to have than bulges, scars, pain or unexplained shocks. Best of luck anyway you go.
"The greatest enemy of knowledge is not ignorance, it is the illusion of knowledge" S Hawking

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freckles1880
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Re: subpec vs. subcutaneous - again

Post by freckles1880 » December 28th, 2012, 6:13 pm

I agree it is your choice. Mine is just under the skin as is most of our members. I was not a big weight lifter with big muscles either when I had my heart attack. But after 3 months of not using my upper muscles I had lost what little I had. I did not know there was more than one way to go and I am not sure they really had a choice for me.
I look at the scar and the lump and just consider it an (life saving) inconvenience. I could not have won any awards for my body's looks before and won't win any today.

So if you want a lesser lump and you are healthy enough go either way you want and the doctors will do.

wavhi
Bob

Medtronic-Visia AF implanted 7-8-2016 stayed with the with 6947 Sprint Quattro Secure lead. Original ICD implant 2-4-2009. ICD turned off 10-6-17 as stage 4 lung cancer taking over.
Major heart attack, carcinogenic shock and quad bypass 10-13-08 post myocardial infarction, old inferior MI complicated by shock and CHF, combined, Atherosclerosis, abdominal aortic Aneurysm, Seroma 7 cm, left leg. Stent in the left main vein 10-7-2014

My "Wardens" are my bride of 54+ years and my daughters.

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Re: subpec vs. subcutaneous - again

Post by notvaporlocked » December 28th, 2012, 7:31 pm

I've had mine for 6 years 3 months and it is under the skin. It shows up as a bump but does not interfere in any way with anything I do. I am 6'4" 200 lbs. It is noticeable but not something I think about because its become a part of me.

Your mileage may vary :)

Terry
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Suzanne
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Re: subpec vs. subcutaneous - again

Post by Suzanne » December 29th, 2012, 12:17 am

Hi Ben and welcome :)

Okay, so your EP knows that your young and thin. Do you value his/her opinion...like has he/she taken the time to explain his/her opinions about either placement?
Like you've read, many sub pec people love their placement...but, the large majority have sub cutaneous placement, and have no issues with that either.
My ICD was sub cutaneous, placed below my collarbone. I didn't like the placement; it should have been placed closer to my armpit.
~ Suzanne ~

St Jude ICD and Lead Implanted Feb.20/09
8 Shock Storm March 21/09
Lead Dislodged, so Replaced with Medtronic Lead June 16/09
ICD and Lead Explanted Nov.23/09
Medtronic Reveal XT (Cardiac Monitor) Implanted Jan.25/10...explanted and new one reinserted on July 21/11

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efpat
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Re: subpec vs. subcutaneous - again

Post by efpat » December 29th, 2012, 11:35 am

Ben, Welcome to the board.

I don't have a lot of advice. Mine is subcut implanted over 3 years ago. No problems with the position or the fact I can see and feel the bump. But its not very prominent. It may sound strange, but I kind of like seeing and feeling it. It's part of me now and I'd freak out if it was gone.

Good luck with the implant and let us know what you did and how it went.

To you and everyone else - have a happy and healthy New Year.
Evan

Cardiomyopathy, LBBB, St. Jude Promote Plus CRT-D Installed Nov 9, 2009, QRS Duration - 180, EF - 25-30, EF NOW IS 50+!!!!!!

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NotinSF
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Re: subpec vs. subcutaneous - again

Post by NotinSF » December 29th, 2012, 9:21 pm

Suzanne wrote:Hi Ben and welcome :)

Okay, so your EP knows that your young and thin. Do you value his/her opinion...like has he/she taken the time to explain his/her opinions about either placement?
Like you've read, many sub pec people love their placement...but, the large majority have sub cutaneous placement, and have no issues with that either.
My ICD was sub cutaneous, placed below my collarbone. I didn't like the placement; it should have been placed closer to my armpit.
He took the time to answer all my questions but didn't want to recommend either way. He said it was up to me. He has been implanting about 150-200 a year for the last 14 years.

If you think that the large majority of people don't have any problems with a subcutaneous placement then that seems like the way to go. Reading all the complaints here its hard to tell.

I'll be honest. I'm really not looking forward to this. Right now it looks like an expensive insurance policy that ill never need. Yes, there's a chance, but it still looks pretty small given my risk factors. I hope I'm able to feel better about things after the implant.

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Suzanne
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Re: subpec vs. subcutaneous - again

Post by Suzanne » December 29th, 2012, 10:11 pm

NotinSF wrote: He took the time to answer all my questions but didn't want to recommend either way. He said it was up to me. He has been implanting about 150-200 a year for the last 14 years.

If you think that the large majority of people don't have any problems with a subcutaneous placement then that seems like the way to go. Reading all the complaints here its hard to tell.

I'll be honest. I'm really not looking forward to this. Right now it looks like an expensive insurance policy that ill never need. Yes, there's a chance, but it still looks pretty small given my risk factors. I hope I'm able to feel better about things after the implant.
Did he give you any pros and cons of either way? That would certainly help you decide.
It's quite understandable that your not looking forward to this whole thing. Hopefully you will never need your ICD, but your Doctor must think there's a possibility. Did you get a second opinion? I think that's very important, and would probably help make you feel you're making the right decision.
~ Suzanne ~

St Jude ICD and Lead Implanted Feb.20/09
8 Shock Storm March 21/09
Lead Dislodged, so Replaced with Medtronic Lead June 16/09
ICD and Lead Explanted Nov.23/09
Medtronic Reveal XT (Cardiac Monitor) Implanted Jan.25/10...explanted and new one reinserted on July 21/11

Cardiac Monitor explanted Sept.9/14

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smc0827
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Re: subpec vs. subcutaneous - again

Post by smc0827 » December 29th, 2012, 10:56 pm

Good Evening,
Speaking as a female, I would have preferred a sub-pec ICD. Obviously for vain reasons dancee but also for reasons that you've probably read about - wires sticking out, the ICD migrating, discomfort with laying on your stomach or moving your left arm across the front of your body when stretching, etc. My 2nd ICD seemed to stick out even more than the first...but I believe you can ask them to create a deeper pocket if possible to avoid that. I don't believe the chance of infection would be greater with one versus the other. I had an infection also the last go around and I would much prefer the scar left by that be under my arm or on my side, rather than right on my chest where it's visible under V necks and tank tops. =/

I read somewhere on the internet when I was researching infection info,that someone had a cardiothoracic surgeon (who is more familiar with the chest muscle anatomy I guess) assist and slide it somehow between the muscles so they didn't actually cut through muscle. If I opt for another, I'm looking into that more. Hope it all goes well! :)
Sue B / MN ~ Family history of various cardiac arrhythmias & SCA. Gene mutation of SCN5A gene.
ICD #1 - Metronic Secura, June 2005 with follow-up ablation in July 2005 for AVNRT. Shock storm April 2008.
ICD #2-Medtronic Virtuoso DR w/lead revision (Sprint lead), June 2009.
ICD #3 Medtronic Protecta DR w/lead revision, June 18, 2012. ICD & lead explant due to allergic reaction & infection on July 10, 2012. Opting not to re-implant at this time.
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NotinSF
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Re: subpec vs. subcutaneous - again

Post by NotinSF » December 31st, 2012, 9:49 am

Suzanne wrote: Did he give you any pros and cons of either way? That would certainly help you decide.
It's quite understandable that your not looking forward to this whole thing. Hopefully you will never need your ICD, but your Doctor must think there's a possibility. Did you get a second opinion? I think that's very important, and would probably help make you feel you're making the right decision.
Hi Suzanne, I got a second opinion. I was hoping he'd tell me I didn't need it. He also told me I needed one. That made me feel worse. ;)

He didn't have much to say about the pro's or con's of either way other than what's been mentioned. I'm also going to see another EP to get a second opinion and learn more about the new S-iCD.

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mrag
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Re: subpec vs. subcutaneous - again

Post by mrag » December 31st, 2012, 11:22 am

Keep in mind you've also probably gotten another opinion and perhaps one that is more 'unbiased' than any of the others. Your insurance company. They just don't indiscriminately hand these devices out. They need a damn good reason to pay for one.
"The greatest enemy of knowledge is not ignorance, it is the illusion of knowledge" S Hawking

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NotinSF
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Re: subpec vs. subcutaneous - again

Post by NotinSF » December 31st, 2012, 12:25 pm

Thanks everyone. Not sure if I have any better idea what to do now than before I asked the question but I appreciate the effort!

:D

If I knew i could get it under the skin without having any problems (with wires poking me, etc) I would go that route. However, unfortunately, I'm not sure any EP wants to actually tell that to me.

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Re: subpec vs. subcutaneous - again

Post by turboz24 » December 31st, 2012, 9:18 pm

I personally wish I had known about the option for sub-pec implantation.

From what I understand, replacement isn't that much different in either location, just that sub-pec is more difficult for initial implantation.

I personally do not look at my ICD. It protrudes quite a bit (visible through t-shirts/polo shirts). The first thing I did when I got home from the hospital was to throw out any shirts that were a little on the snug side.

People think It's vanity, but for me I'd rather not be constantly reminded that's it's there by seeing it all the time. I get reminded enough when I get shocked or it hurts (and 5+ years and I still "feel" it, doesn't go away...)

I'm up for replacement early/mid 2013 and the discussion with my current EP will go this way.

1. Will the sub-pec implant reduce the pain I experience with the sub-cutaneous location?
2. Will the sub-pec location cause problems when bench pressing heavy weights?

Now If I had to choose between the current occassional pain/discomfort, never taking off my shirt and being very careful what I do (to prevent getting hit on the ICD, which hurts a lot.....) vs additional pain or having to stop weight lifting, I'll take the first option.....

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