Korean Circ J.  2008 Sep;38(9):500-504. 10.4070/kcj.2008.38.9.500.

Two Cases of an Implantation of a Permanent Pacemaker Using a Transaxillary Incision

• Choi JH
• Kim J
• Park TI
• Jang HH
• Lee TK
• Lee SK
• Lee HC
• Kim JH
• Chun KJ
• Hong TJ
• Shin YW

• KMID: 1776352
• DOI: http://doi.org/10.4070/kcj.2008.38.9.500

Abstract

In surgeries that require the implantation of a pacemaker, the endocardial pacemaker leads are introduced into the cardiac chambers through subclavian or axillary venous catheterization or cephalic vein cutdown. The drawback of this type of surgery is scarring of the pectoral area, which can be a serious cosmetic problem especially for young women. In this study, we report on 2 cases where a permanent pacemaker in two young women with symptomatic bradycardia was implanted using a transaxillary incision. Both patients successfully recovered with no complications and were asymptomatic for more than 17 months after the procedure. Therefore, we found that implantation of a pacemaker via transaxillary incision provided excellent cosmetic results and should be considered in young women that require this type of surgery.

Keyword

Pacemaker; Axilla

MeSH Terms

Axilla
Bradycardia
Catheterization
Catheters
Cicatrix
Cosmetics
Female
Humans
Venous Cutdown
Cosmetics

Figure

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  Fig. 1 Twelve-lead electrocardiogram showing a sinus rhythm and an alternating bundle branch block {Left bundle branch block (◯) and right bundle branch block (↑)}.

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  Fig. 2 Electrocardiographic findings of case 1. Electrocardiograms (aVF, V1 and V2 leads) showing a sinus rhythm with complete blockage of the right bundle branch, followed by type-II second-degree AV block and a long duration of ventricular asystole (A). A high-grade AV block that was spontaneously resolved (B).

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  Fig. 3 Electrocardiographic findings of case 1 eleven days after presentation. Electrocardiogram showing a type-II second-degree AV blockage with a long ventricular aystole (A and B) accompanied by seizure-like motions of the patient.

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  Fig. 4 Images of case 1 after pacemaker implanatation. The chest X-ray showed that the leads were appropriately implanted without any complications (A and B). The pacemaker pocket wound is along the anterior axillary line (C and D).

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  Fig. 5 Twelve-lead electrocardiogram of case 2 showing sinus bradycardia.

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  Fig. 6 Twenty-four hour Holter electrocardiogram showing a marked sinus bradycardia followed by a single premature ventricular beat (third QRS complex) and then a premature ventricular beat (fifth QRS complex) initiating polymorphic ventricular tachycardia (↔).

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  Fig. 7 Images of case 2 after pacemaker implanatation. The chest X-ray showed that the leads were appropriately implanted without complication (A and B). The pacemaker pocket is invisible from the anterior view (C) and located along the anterior axillary line (D).

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