A pacemaker pocket is the area of the skin where an incision is made and a pacemaker is inserted. It is usually inserted beneath the collarbone, either in the lower shoulder or upper pectoral area. The generator is placed in the pocket and two leads are then attached to the right ventricle and atrium through an artery. In most cases, the pacemaker pocket will be made on the left-hand side of the body.
A round generator is inserted into an area of skin or muscle. When a replacement is needed, the new generator will be placed in the same area as the first. By doing so, the procedure is less invasive than inserting the device closer to the heart and it is easier to do replacements later on.
Occasionally, the pocket will become infected. In this case, antibiotics are often given and a new generator is inserted. Many times the entire system, including the leads, is removed and a new one is put in place. There are newer procedures available which can sometimes preserve the leads in order to make surgery less invasive altogether for the patient.
Additional advances have also been made to help prevent continuous pacemaker pocket infections. There are specialized linings made from mesh which can be inserted into the pocket. These are made with antibacterial agents to help kill any bacteria which could potentially cause infection. Most infections related to a pacemaker enter at the incision.
The pacemaker pocket may be visible by looking at the chest, but many patients only experience minimal scarring after the procedure is done. Routine maintenance is required to ensure that the generator has plenty of battery life and that the device is working properly. Visits are also required to ensure the pocket is healing well and that the patient is experiencing no pain or tenderness at the incision area.
Signs of a pacemaker pocket infection include redness, soreness, pain, bleeding, oozing of pus around the incision, fever, and in severe cases, nausea, vomiting, and chest pain if the infection has spread into the chest cavity. Morbidity rates are much higher among patients with frequent or serious pocket infections. Symptoms should be checked and treated by a doctor immediately to avoid serious complications.