Device Pocket Challenges in Elderly and Thin Individuals

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.