Boca Raton Regional Hospital Explores New, Alternative Site for Cardiac Pacemaker and Defibrillator Implantation

Use of axillary fossa provides excellent option for patients, especially those in the elderly population

BOCA RATON, FL – May 7, 2019 – In an article recently published in The Journal of Innovations in Cardiac Rhythm Management, doctors at Boca Raton Regional Hospital are exploring the use of the axillary fossa (the hollow of the armpit) as an alternative site for implantation of cardiac pacemakers and defibrillators.

According to E. Martin Kloosterman, MD, FHRS, FACC, Jonathan Rosman, MD, FHRS, FACC and Murray Rosenbaum, MD, FHRS, FACC, the lack or inadequate thickness of subcutaneous tissue in certain patients can give rise to significant problems for those with – or requiring – cardiovascular implantable electronic devices (CIEDs).

“While not entirely exclusive to the elderly, older patients certainly have a higher incidence of fragile tissue and thin subcutaneous fat layers,” noted Dr. Kloosterman. “This, in turn, can lead to pressure from a device being placed on the tissue and give rise to erosion, infection, discomfort and hypersensitivity at the implant site.”

Normally, CIEDs are implanted in subclavicular locations (below the collarbone). For patients with sensitivity issues, an implant under the pectoral muscle has served as a viable alternative. Yet, there remains a certain patient subgroup with thin or atrophic pectoralis muscle, which can foster excessive device protrusion, or those who are experiencing difficulties with prior implantation of a device in that area.

In examining the axillary fossa as a viable option as an implant site, the doctors, who are all electrophysiologists at Boca Regional’s Lynn Heart and Vascular Institute, found several compelling advantages.

First, the area usually has a preserved fat pad, even in thin individuals.

Second, the site remains unperturbed by arm movement and does not have any direct exposure to contact.

Lastly, the site is easily accessed, with no significant compromise of neurovascular structures and is in close proximity to the conventional subclavicular implant location.

“Our initial experience with the use of the axillary fossa as an alternative location for device implantation has been quite encouraging,” commented Dr. Kloosterman. “All of the procedures were well-tolerated and the devices were well-seated with proper and adequate function.”

Moreover, Dr. Kloosterman characterizes the axilla as essentially a “protected space” with no direct contact to other body structures or external elements such as clothing and seat belts. It is also not subject to pressure from sleeping or lying on the site.

“The axillary fossa offers an attractive alternative site for device implantation when addressing both clinical and comfort concerns of our patients,” he concluded. “Its use is a novel technique conceived and developed at our institution, and provides substantive benefit, especially to those in the elderly population.”

Boca Raton Regional Hospital – Advancing the Boundaries of Medicine.
Boca Raton Regional Hospital is an advanced, tertiary medical center ( with 400 beds, 2,800 employees and more than 800 primary and specialty physicians on staff. The Hospital is a recognized leader in Oncology, Cardiovascular Disease and Surgery, Minimally Invasive Surgery, Orthopedics, Women’s Health, Emergency Medicine and the Neurosciences, all of which offer state-of-the-art diagnostic and imaging capabilities. The Hospital is a designated Comprehensive Stroke Center by the Florida Agency for Health Care Administration (AHCA). BRRH is recognized in U.S. News & World Report’s 2018 – 2019 Best Hospitals listing as a Top Ranked Regional Hospital, for the fourth consecutive year, and the highest ranked hospital in Palm Beach County.

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