title: Left axillary pacemaker generator implantation with a direct puncture of the left axillary vein.
abstract: BACKGROUND
  Pacemaker generators are routinely implanted in the anterior chest. However, where to place the generator may need to be considered from the mental, functional, and cosmetic standpoints.
  
  
  METHODS
  In this study, we performed the left axillary pacemaker generator implantation with a direct puncture of the left axillary vein in 40 consecutive patients, and evaluated the late safety and efficacy of this implantation. Complications, changes in the lead sensing, pacing threshold, and impedance were used as safety indexes for a mean follow-up of 3.4 years. In addition, the efficacy was also evaluated by comparing their questionnaire survey results to 119 patients in a control group of anterior chest implantation.
  
  
  RESULTS
  Lead dislodgements were observed in two patients of the experiment group. There were no migrations of generators from the implantation site or abnormal variations in the pacing threshold, lead sensing, or impedance. In the left anterior chest and left axillary groups, 85% and 10% of the patients were worried about an external impact, 80% and 25% were worried about electromagnetic interference, and 68% and 0% answered that the pacemaker implantation site was noticeable, respectively. Apparently, more patients had a sense of security and cosmetic satisfaction with the left axillary implantation.
  
  
  CONCLUSIONS
  The left axillary generator implantations may reduce the mental burden and cause no safety concerns, and may be performed if functional or cosmetic outcomes are required.
authors.affiliation: Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Meguroku, Tokyo, Japan.
authors.forename: Mahito
authors.initials: M
authors.lastname: Noro
authors.forename: Xin
authors.initials: X
authors.lastname: Zhu
authors.forename: Takahito
authors.initials: T
authors.lastname: Takagi
authors.forename: Naohiko
authors.initials: N
authors.lastname: Sahara
authors.forename: Yuriko
authors.initials: Y
authors.lastname: Narabayashi
authors.forename: Hikari
authors.initials: H
authors.lastname: Hashimoto
authors.forename: Naoshi
authors.initials: N
authors.lastname: Ito
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Enomoto
authors.forename: Keijirou
authors.initials: K
authors.lastname: Nakamura
authors.forename: Shingo
authors.initials: S
authors.lastname: Kujime
authors.forename: Tuyoshi
authors.initials: T
authors.lastname: Sakai
authors.forename: Takao
authors.initials: T
authors.lastname: Sakata
authors.forename: Kaoru
authors.initials: K
authors.lastname: Sugi
mesh_terms: D000328:Adult; D000368:Aged; D001367:Axillary Vein / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000379:methods*; D011677:Punctures; D055815:Young Adult
keywords: cosmetic outcome; direct axillary vein puncture; functional; left axillary generator implantation; mental burden