The recessed chest wall pacemaker pocket

Permanent pacemaker lead implantation via azygous vein in a patient with silent superior vena cava syndrome

Occlusion of the superior vena cava is a rare but serious complication of transvenous endocardial pacing. We describe an unusual approach for permanent pacemaker implantation using the azygous vein in a patient with occlusion of the bilateral total subclavian and innominate veins after previous bilateral pectoral pacemaker implantation. Endocardial pacing using the azygous vein with minimal invasive thoracotomy may be a good option for patients with inaccessible subclavian route.

Contractile fibroblasts (myofibroblasts) in a painful pacemaker pocket

Electron microscopy of a painful fibrotic capsule around a cardiac pacemaker revealed classic myofibroblasts. These contractile fibroblasts share characteristics of both smooth muscle cells and fibroblasts and are thought to be the cellular cause of wound and scar contraction. The occurrence of pain and tenderness around a sterile pacemaker probably indicates contraction of scar tissue as the basis of the symptoms. This scar tissue is similar to that seen around other large inert implants placed in the thoracic tissue.

Manual extraction of a permanent pacemaker: an attempted suicide

An unusual case of a patient-related pacemaker malfunction is presented. In a suicide attempt the patient manually extracted a subcutaneously implanted permanent pacemaker. This shocking example of pacemaker manipulation by a patient raises the question of the need for more routine of protected sites for pacemaker implantation.