Join now

Already a member? Sign in

Welcome to Inspire!

What - Inspire is a place where you can connect with people who share your health concerns and find information and advice in groups sponsored by organizations you know and trust.

Why - As a member you can use Inspire to let friends and family know how you're doing, contact others who share your health concerns, receive personalized updates and information about participating in surveys and clinical trials, and more.

How - Joining Inspire is completely free and usually takes less than a minute. Join now!

corner corner corner

ICD - subdermal or subpectoral?? Help!

MissCaro
  • By MissCaro
  • Posted June 15, 2009 at 4:53 am · 17 replies
  • Shared with the public
0 Recommendations

I've just been given the news that I need an ICD because of my regular bouts of VT and the unsuccessful ablations. Apparently I have ARVD which is a degenerative disease so the need for an ICD will become greater as I get older. I'm only 27 so this news is a little daunting.

I asked my cardiologist whether it would be possible to get the ICD implanted under the muscle rather than just under the skin so that it's less visible and more securely implanted. His reply was that the hospital no longer do this because the device tends to rub against the ribs over time which can cause complications.

My question is whether anyone else has been told something similar and what the general consensus is regarding ICD placement. I'm looking at an implant for life so I want to be sure to get as much info about this as possible. Your experience and advice is much appreciated :)

Explore topics in this journal entry and replies:

Exercise Heart failure Surgery Heart attack

17 replies

Nancy-in-KC

Hello Miss Caro, I had my ICD implanted in April of this year. Mine is a subdermal implant. I briefly thought about subpectoral, but I think mine would have shown either way. I understand that implanting under the muscle is a longer healing period, and realizing that I would have to have it replaced periodically, I opted for subdermal. My recovery was very uneventful, the device has settled in to place quite nicely, and I am doing great two months out.

Nancy

kardia

MissCaro,

I am sorry you have to have this ...on the bright side, it may save your life, and it is not that bad, once it heals up. Just a little bump. If you don't carry a lot of weight on top, I don't, the adjustment to not wearking strappless outfits for a while was a challenge. Now, I am really too old, so oh well. But, it does heal, and I have seen many beautiful women with ICD Inplants wearing strappless dresses.

I know the idea of having that thing anywhere in my body was upsetting, but necessary. My experiece now tha I have lived through the first battery cycle, is that I think I want it to be accesable for recharging every few years, that way it is not as severe of an operation. It will be 3.5 years (half the life of the ability of the battery) for me because of all the charges/shocks I had.
So, my fear is always building up unneeded scar tissue.

Hope this doesn't discourage you, and helps a little. I look at it as an important part of my body's mechanism now.

jeanncnc

my icd was placed may 09 so new. i was just glad to know that icds are an option. i am doing great , just under the skin healed nicely . wish you luck

oleblueize

Mine is also under the skin, implanted 2/09 and doing well. I am fair so the incision line is still red but in time that should go away. Good luck. If itwill keep you alive- it is worth it...

lovefelts

good question. one more thing you might like to consider, even though you are young. I have had my icd for almost 3 years. (i am 45) I did not have any choices as I was unconscious when implanted. Mine has settled down into my left breast. As a thin woman I now have extra bulk on one side. that and the wearing strapless for the bulk and scars doesn't bother me. however 1 1/2 years ago I went for my physical and the Dr. said I was due for my annual mammogram. impossible to do on my left breast. so they scheduled me for a sonogram. they found 2 lumps. (said they wouldn't have caught on a regular mammogram) very small. i have had them biopsies and they are watching them. but they all recommend that i have the icd moved to allow mammograms, as they are truly the best diagnostically. As a woman patient, I don't think the men who are doing these implants with ICD's think to the future. Sorry to give you one more thing to consider, but, I hope this helps.

MissCaro

Hi Ladies,
Thank you so much for sharing your experiences and advice. I definitely have a lot to think over but your comments have really helped. Wishing you all the best :)

Carolyn

cmc2131

Hi Carolyn,
I was subpectorally implanted in June 08, also for recurrent VT. I did a lot of research re: subderm vs subpec and I never heard the excuse 'it rubs on your ribs'. I'm very active and athletic and I would not have tolerated a subderm ICD. My device specialist (a different doc from my EP) said he only does subpec implants on active young people. I would definitely get a second opinion. I have zero problems with my subpec ICD, I climb, backpack, ride my bike with a messenger bag over my left shoulder, never any problems, I'm pretty skinny 5'10 150pds. Also, please get 2nd opinions on your ARVD, I met several criteria for ARVD but it took many months and the full genetic tests to find that I did not have ARVD, the difference in diagnosis will change how you live your life. I have a blog about my VT experiences: http://v-tach.blogspot.com/
best,
craig

Julie5

Hi Carolyn,
I, too, have an ICD and have had it for almost 3 years. Mine is just under the skin, and like one of the above posts, it has settled in just above my left breast. It doesn't bother me, and sticks out just a bit. The cosmetic appearance doesn't bother me either. I wear tank tops, etc... I'm very athletic - run, bike, hike and it all works just fine. If you do get your ICD under the muscle, remember that it does take longer to heal and keep in mind that batteries will need to be replaced now and then - so, they'll have to cut through muscle each time.
Good luck and welcome to this site!
Julie

laurali

Hi! I have had my ICD for 3.5 years. I never wore strapless dresses, so didn't need to think about that! Mine is under the skin and doesn't show at all. I am fair and the scar is so faint that I can hardly see it in the mirror. I do wear swimsuits, tank tops, etc. and am very active. I didn't have a choice as mine was an emergency. But, I think I would have chosen this anyhow. It should be very easy to get in and out to change batteries, it doesn't get in the way of mammos, and my healing was uneventful and quick. But, I guess it really depends on how you are built. I'm tall, broad shouldered, and high-average weight for my height. Good luck. Hugs, laurali

icdmom2

Hi Miss Caro,
My son was 15 when he suffered cardiac arrest and got his ICD. The doctor felt that as a young man it would be more attractive not to have a lump on his chest and placed it under the muscle. He never had any problems with it. He went on to get his second degree black belt in karate and work out regularly. Last August he had a new one put in. It healed well and fairly quickly. The doctor said it was very difficult to pull out and put the new one in the pocket from the old one. He suggested the next one be under the skin. My feeling is that is for his convenience and ease, and not related to any complications from the placement. My son is now 23 and doing fine. Good luck to you.

Gammacygnus

Hi I'm on my fourth implanted device that's subdermal. I've had few times would getting pulling sensations but other then that no problems. Scar is but a faded white line. Since I'm on the thin side the device does show but I do wear tank tops, swim suits and great dresses to wear. I've had an ICD,2 different Bi-vent CRT and currently a heart failure pacemaker/defibrillator, this one has been implanted since Dec/2007 and I go through batteries about every 3 yrs or so, replacement is getting closer.

MissCaro

Thanks everyone for your feedback. Has been very helpful and informative and given me a few things to discuss with my cardiologist. At this point he's still investigating the diagnosis of ARVD so he would like to repeat the MRI which means the ICD has been postponed for a few months. Thanks again for sharing your experiences and advice. Good luck!

MissCaro

Craig - I actually stumbled across your blog a few months ago and found it very interesting and inspiring. I'm curious about the genetic testing you had done. I'm Australian and my cardiologist has mentioned that I can pay a few thousand to get tests done in the U.S or Denmark. My understanding is that if the tests come back negative that doesn't exclude the possibility that I've got ARVD as researchers still haven't identified all the associated genes. What was your experience?

cmc2131

Yes, that's true. Although considering the number of genes currently identified and the number of people in the studies, as new genes are identified the population with those gene mutations must be pretty small. The larger concern, I think, is the number of diagnostic criteria you have, coupled with the presence of a gene mutation. (http://www.arvd.com/diagnosis_crit.html)
In my case I have 3 or 4 minor criteria (depending on how you chose to read my ventricular dilation -a common phenomenon in endurance athletes). I have no major criteria and my MRI is clean of fatty tissue. My EP is pretty circumspect about the different manifestations of ARVD and ARVD-like symptoms. I am in a grey zone, and many EPs would probably class me as ARVD positive despite my negative genetics. So if you are borderline, as I am, I think the genetic testing is even more important.
My EP's theory is that the absence of a genetic marker, no family history, my limited number of symptoms, and my history of participation in high-level endurance sports in which I traveled widely and was exposed to different viruses and bugs, indicates I probably have acquired scaring that in many ways mimics classic ARVD. I am willing to go with that, and so far, since my ablations, my cardiovascular performance has vindicated this approach. I have had no disease progression, no sustained VT and far fewer PVCs and my fitness is back to where it was before all this started. The ICD is insurance against ablated tissues coming back "on-line" over time.
Are you aware of the ARVD support group? (http://health.groups.yahoo.com/group/mmettera/) From regular reading of the posts on this group it seems that there are many different ways that the disease progresses, some cases are clear cut, others are far more ambiguous. Because there are numerous ways one could end up with a scared heart it seems important to eliminate all other possibilities before locking in on ARVD. The classic ARVD moratorium on exercise would be unfortunate if given to someone who does not have progressive ARVD.
To my mind if you have had recurrent VT and been ablated, even if you are ARVD negative, an ICD is not a bad idea. I've been totally satisfied with mine, of course I've never been shocked! I'd be pretty nervous about exercising without it. Unfortunately with the state of US healthcare I don't know how I'll be paying for my next ICD when I get out of school. Fortunately my current insurance has covered everything including the genetic testing.
Are you aware of the number of criteria you have? Good luck with your continuing diagnosis. I hope it all comes out positive, that is to say negative!

Misty1482

Carolyn, I too am 27 years old. I had a Massive Heart Attack at 26 while pregnant. Its been a year since all this happened(aug 16th). But anyway, they sent me home from the hospital with a wearable defibrillator called a LifeVest. They sent me home with it, because my heart was not healing the way they expected. I was in hospital for 2 weeks and had a triple bypass done. So they wanted to give it time before they decided on anything. 3 months later, I had my ICD implant. They said I can get really bad arrythymias that could cause me to die, so I said ok lets put the ICD in. I was scared but I'm used to it now. I even thanked the dr who did it. He put mine under my muscle and didnt say anything about it rubbing my chest bones. I have 2 kids, my little girl just turned one on aug 21st and my son is 8 and I run around with them without a problem. It didnt seem like it took longer to heal, but I dont have anything to compare it to..lol. The doc said it looked really good for it being put in a week ago, so maybe I was lucky. It was swollen for another week or so, but I wear all kinds of tops. Spagetti strap, strapless, tank, it doesn't bother me and I even have a scar from open heart surgery that runs from my upper chest to just below my chest. It bothered me at first, but I got over that within a few months(this was before the ICD). I am about 5'4 and 120 pounds. Its settled in pretty good, but you can still see the lump if you look sideways at it. you can barely see the scar where they put it in. He told me I would need a battery change every 5 to 7 years, I have had this since Dec 18th, 2008 and have not had to use it (knock on wood) and hopefully you wont have to have to use it either. I have talked to a few people who have had theirs for 5 or so years and they just needed battery changed. But I know that if i ever need it, then it will be there for me. I told my drs I will be here to see my children graduate HS and get married and see my grandchildren, nothing is coming in my way and stopping me...lol. Best of luck to you sweetie and keep us posted on what is going on with you and your decision. It was the best decision I made.
Lots of Love,
Misty

sgriggs89

Hey, Miss Caro! I'm 38, and my ICD is tucked under the pectorial. I haven't experienced any negative issues other than the expected initial discomforts. I knew I would be sore for a couple of weeks, and I slept in an arm sling for six weeks to limit movement at night. Swimming this summer really did the trick to loosen and stretch my left arm, so I have a full range of movement.

Lydjahh

Mine is sub-pectoral and has been no problem at all. It wasn't all that uncomfortable, maybe because the broken ribs from CPR was worse. The subdermal ones stick out and they seem to me to be more vulnerable to injury. In older folks that really wouldn't be an issue. Good luck!

Add to the discussion

Don't have an Inspire account? Join now!

Forgot password?

You