Over the years, awareness in the increased risk of sudden death in women due to cardiac diseases and inherited cardiac conditions has been raised. Thus, more women are now diagnosed with such conditions leading to the increased use of implantable cardioverter defibrillators (ICDs).
What is an implantable cardioverter defibrillators (ICD)?
The implantable cardioverter defibrillator designed to slow down a fast heart rate using electrical pulses or shocks and can treat life-threatening arrhythmias (usually ventricular tachycardia or ventricular fibrillation) that can cause sudden cardiac arrest (SCA).
An ICD is implanted in a similar way to pacemakers, where it is a battery powered small device placed under the skin in the chest area and attached to one or two leads (thin, coated wires), which are placed in or on the heart muscle.
Concern in young women with ICD placement
Traditional placement of ICDs results in the bulky battery (generator) placed below the collar bone. This would not only lead to small but visible scars, discomfort and irritation from bags or bra straps but also affects the overall body image. Changes in their body image, hesitation about what clothes to wear, anxiety about social interactions can decrease young women’s self-esteem. Limitation on strenuous physical activities further adds to the negativity in young women.
In a survey of female patients below the age of 40 years old with pacemakers / ICD, 63 % were worried about how their clothes fit with the ICD. Three quarters of the patients felt the ICD interfered with social interactions, while 50% were concerned about sexual encounters. More women (89%) than men (43%) reported anxiety over wearing a swimming suit. Therefore, the option of having a hidden ICD /pacemaker should be discussed with female patients.1
Addressing these concerns with different techniques
Electrophysiologists can collaborate with plastic surgeons to hide pacemakers and ICDs below the breast tissue. (submammary placement) By placing the incisions in natural skin folds and positioning the bulk generator behind breast tissue, it is possible to have a near-visible pacemaker or ICD. Such placement is much more comfortable when carrying shoulder bags and wearing bra straps, minimizes body image concerns and are welcomed by many female patients. Furthermore, the performance of the ICD or pacemakers are not affected and patients can still have mammograms as needed.
With these considerations in mind, 2 young ladies who required life-saving ICD therapy had successful implantation of submammary ICD, the first such implants in Southeast Asia.
Picture source from: Singapore Medical Journal
To read more information of submammary placement of implantable cardioverter defibrillators:
1 Dubin AM, Batsford WP, Lewis RJ, Rosenfeld LE. Quality-of-life in patients receiving implantable cardioverter defibrillators at or before age 40. Pacing Clin Electrophysiol. 1996;19:11 Pt 1 1555-9.
Article source: Singapore Medical Journal