Pacemaker Pocket Stabilization Utilizing a Novel Envelope and a Three-Point Anchoring Technique.

A 65-year-old man presented with chronic pain due to frequent movement of a dual chamber pacemaker (PPM) within the device pocket despite being secured to the underlying muscle. Due to chronic pain and possible indolent infection, the PPM was removed and a new device was implanted on the contralateral side via a persistent left superior vena cava. To prevent device movement, it was placed within a CanGaroo® envelope (Aziyo Biologics Inc., Silver Spring, MD, USA), which was secured to the underlying muscle with a silk suture along three of its corners. The envelope, which becomes incorporated into the surrounding tissue forming a vascularized tissue pocket, should further reinforce device stability over time. The patient's left-sided symptoms abated immediately and he remains free of symptoms on the right side over a six-week follow-up period.