Abstract
Aging results in loss of subcutaneous body fat as well as lean body mass. Elderly patients are also more likely to require cardiac implantable electronic devices (CIED) due to rising cardiovascular disease prevalence. A majority of the currently available devices require placement in a pocket created in the subcutaneous space between the subcutaneous fat tissue and the underlying chest wall muscle. Deficient subcutaneous fat tissue can result in device protrusion and even erosion through the skin. This can lead to significant morbidity and mortality especially when associated with device infection and need for device system extraction.This article reviews the scope of the problem and some of the strategies that can be employed to address the lack of subcutaneous soft tissue at the time of device implant.
Highlights
BackgroundThe world population is aging and the proportion of individuals above 65 years of age is projected to increase from 6.9% to 12% between 2000-2030 [1]
Aging is associated with increased risk of cardiovascular disorders and a need for cardiac implantable electronic devices (CIED) [2]
Aging is associated with body fat redistribution and a general loss of subcutaneous fat [3]
Summary
The world population is aging and the proportion of individuals above 65 years of age is projected to increase from 6.9% to 12% between 2000-2030 [1]. The placement of the CIED generator in a submuscular pocket deeper than the usual subcutaneous pocket is an effective technique to achieve an aesthetically effective device pocket without any prominent bulges or protrusion The presence of another layer of soft tissue in the form of chest wall muscle decreases the risk of device impingement on the skin leading to skin erosion. The results in a case series of 24 elderly patients, with thin subcutaneous covering over their pockets, treated with matrix reinforcement was very encouraging [9] This case series followed 24 patients with a mean age of 80 years, 14 with pacemakers and 10 with implantable cardioverter defibrillators (ICDs), who were deemed to be at risk for immediate skin breakdown due to thin soft tissue over their devices. Anecdotal and early research experience is promising; more experience and scientific data are needed before use of extracellular matrix to reinforce the device pockets of thin patients can be routinely prescribed
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