LAUSR

Physicians should be aware of the rare occurrence of the subpectoral hematoma, which may need incision of the pectoral muscle for evacuation. Introduction Cardiac implantable electronic device (CIED) implantation is a common electrophysiology procedure and almost 300,000 devices are implanted yearly. The procedure of CIED implantation is safe, with the risk of complication close to 1%. Complications may include infections, bleeding and pocket hematoma, lead dislodgement, perforation, pericardial effusion, and tamponade. The most common reported complication is pocket hematoma. Bleeding in the pocket can lead to significant discomfort, increases risk of infection, and may require surgical drainage. While hematoma formation has not been associated with increased mortality, it can lead to increased length of stay and costs of hospitalizations. There are multiple sources fromwhich bleeding in the pocket may occur and result in hematoma formation. These include injury to superficial veins, vascular breast tissue, insertion site vessel, andmuscular arterial branches. The bleeding from these sites usually results in the bleeding in the pocket. In this report we present a rare location of bleeding into the subpectoral muscle after upgrade of a dual-chamber pacemaker to biventricular implantable cardiac defibrillator (BIV-ICD).