Morphometric parameters of cardiac implantable electronic device (CIED) pocket walls observed on device replacement

Background: The final stage of a conventional de-novo cardiac implantable electronic device (CIED) implantation procedure with transvenous lead insertion involves the formation of a pocket by tissue separation superficial to the pectoralis major muscle in the right or left infraclavicular region, where the device is subsequently placed. Over time, a scar “capsule” is formed around the CIED as a result of normal biological remodelling. Materials and methods: The purpose of this study was to analyse the structure and present the variations of CIED capsules observed during device replacement. The nature and extent of this local tissue remodelling, which had occurred from the time of device implantation to its replacement in 2016 (10 ± 3.1 years), was analysed in 100 patients (mean age 77.1 ± 14.5 years), including 45 women and 55 men. Results: The most prevalent types of “capsules” (70% of cases) were those with similar thickness of both walls or a slightly thicker posterior (< 1.0 mm) than anterior wall (< 0.5 mm). The second most common capsule type (23% of cases) was characterised by a significantly thicker posterior wall of scar tissue (> 1.0 mm). The third group of capsules was characterised by various degrees of wall calcification (7% of cases). Conclusions: The extent and nature of scar tissue structure in the CIED pocket walls seem to correlate with the relative position of cardiac lead loops with respect to the device itself; where the more extensive scarring is likely to result from pocket wall irritation in the capsule formation phase due to lead movements underneath the device. The group of cases with calcified capsules was characterised by “old” device pockets (> 13 years) and the oldest population (patients in their 80s and 90s)