POLAND SYNDROME: A NOVEL APPROACH TO PACEMAKER PLACEMENT

Abstract

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Poland Syndrome (PS) is a rare congenital defect characterized by unilateral underdevelopment or absence of the pectoralis major muscle associated with ipsilateral cutaneous syndactyly, or webbing of the fingers. [1] PS poses a major surgical challenge for providers when a patient requires the placement of a pacemaker or implantable cardioverter defibrillator (ICD). Traditionally device implantation utilizes the structure of the pectoralis muscle to create a pocket for the device to sit in and a structure for the device to be anchored to, preventing migration. [2] However, in PS this is not possible because of the absence of the pectoralis muscle. We present a unique case of a patient with PS and advanced conduction system disease in whom we utilized a novel technique to anchor a pacemaker. CASE PRESENTATION: An 80-year-old male with a history of PS, non-obstructive coronary artery disease, and chronic conduction system disease who presented with exertional dyspnea, fatigue, and found to have progression of his conduction system disease with LBBB, 2:1 AV block, and symptomatic bradycardia. Imaging confirmed the absence of the left pectoralis muscle. Given he was right hand dominant, he refused pacemaker implantation on the right and specifically requested it be placed on the left side of his chest. Due to the congenital absence of the pectoralis major on the left, a novel approach was taken and the pacemaker generator was successfully anchored to the periosteum of the first rib to prevent device migration. DISCUSSION: Progressive conduction system disease with symptomatic bradycardia is a class 1 indication for pacemaker placement. Therefore, in this patient who refused pacemaker placement on the right side, a novel approach was developed for pacemaker placement in the absence of the pectoralis muscle. CONCLUSIONS: PS is a rare congenital anomaly when present poses significant challenges in patients who require either a pacemaker or ICD. We present the first case in literature where a unique and innovative approach is taken to implant and secure such a device on the side affected by PS by successfully anchoring it to the first rib periosteum to prevent it from migrating. Reference #1: Benzalim M. Poland syndrome: about a case and review of the literature. Pan Afr Med J. 2017 26: 12. Reference #2: Kotsakou M. Pacemaker Insertion. Ann Transl Med. 2015 Mar; 3(3): 42. DISCLOSURES: No relevant relationships by Kristen Brown, source=Web Response No relevant relationships by Stuart Cavalieri, source=Web Response No relevant relationships by Gurpreet Johal, source=Web Response