Subpectoral Implantation of Cardiovascular Implantable Electronic Device: A Reasonable Alternative for the Conventional Prepectoral Approach

The prepectoral implantation technique has been the standard procedure for cardiovascular implantable electronic device (CIED). However, it cannot be performed in such patients with thin skin or patients with cosmetic concerns. This study was designed to demonstrate the feasibility and safety of the subpectoral compared to the prepectoral approach.
We conducted a retrospective, nonrandomized comparison of the prepectoral (234 cases) and subpectoral approach (32 cases) in patients who received CIED implantation at a tertiary center between July 2012 and May 2015. We compared lead characteristics, procedure time and complications between the subpectoral and prepectoral approach.
In the subpectoral group, two complications were observed, whereas six complications were found in the prepectoral group (2/32 vs. 6/234, respectively, p=0.25). In the subpectoral group, one patient developed wound infection and the others were safely conducted without any complications. In the prepectoral group, two patients developed hemopericardium, three developed pocket hematoma requiring surgical revision, and one developed a pneumothorax. Procedure time in the subpectoral group took longer than that in the prepectoral group (150±50 min versus 91±49 min, p=0.06). In lead characteristics, there were no significant differences between the two groups.
The subpectoral approach is technically feasible and non-inferior to the prepectoral approach, in the aspect of complication and lead characteristics, but seemed to take more procedure time. The subpectoral approach is a more reasonable choice for selected patients in whom the prepectoral approach is not feasible or in individuals who have cosmetic concerns.