Abstract Body: Background: Implantable Cardiac Monitors (ICM) have become standard practice for monitoring of arrhythmic events. Manufacturers recommend 3 primary angles of orientation (AO) at implant. Langer's lines (LL) and reduced tension have shown differences in scar formation. The AO can effect healing, scarring as well as sensing of the ICM. It may also impact explant time and instrumentation as well. No studies to date have evaluated the incision sites at the time of explant in regards to ICM’s or healing details and the impact of the AO.

Hypothesis: Current AO of ICM implants are parallel to the sternum is Oblique to Langer's Line incision and reduced tension will effect the scaring and explant based on their relationship to LL
Goals: We set out to evaluate if Langer's Line incision and reduced tension effected the scar characteristics and explantation details of ICMs by their relationship to AO

Methods: We prospectively compared consecutive patients to see if AO demonstrated differences when comparing parallel to sternum AO vs. other positions at the time of explant. Groups were assigned as (A) Oblique inferior to LL, (B) Oblique lateral to LL, and (C) Perpendicular orientation. In addition, a skin/scar analysis consisting of atrophy, color, and contour were scored as non-significant (0), mild (1), moderate (2), and severe (3). Explant instruments and level difficulty was also classified on a 0-5 scale.

Results: N=29 patients (12M:27F) mean age 60.3(+/-14.9) were included in our analysis. Scar features, skin scoring, and explant data were assessed and presented in Image 1.

Conclusion: AO played no role in extraction comparing parallel to all other vectors. Level of difficulty was graded higher but did not reach significance. Orientation C (Perpendicular) demonstrated a shorter explant time in sub-analysis.