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August 19, 1974

Subcutaneous Pacemaker Placement

JAMA. 1974;229(8):1045-1046. doi:10.1001/jama.1974.03230460013009

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To the Editor.—  I have read the article by Kim et al (228:74, 1974) concerning the fixation of a subcutaneous pacemaker pulse generator by use of an anchor suture to the clavicle, which is a fixed point in the anatomy of the chest wall. Certainly, this suggestion has merit. However, a recent letter by Azzam (228:1368, 1974) seems to me to be an incorrect approach to the same problem. The resolution of the problem of displacement of an electrode pulled by a heavy pacemaker should not be "suturing the lead to the fascia of the pectoral muscle." That will not solve the problem, but will convert the point of fixation to the electrode itself. If the heavy pacemaker then continues to drop, the pull will be on the electrode not with distraction of the electrode from the vein, but the highest point of suture fixation. Under those circumstances, it is almost