Optimization of pacemaker pocket-Revisiting the fundamentals.

The incidence of pacemaker-related infections including pocket infection or erosion in previous study was 0.68%, and increased yearly in long-term follow-up.1 Until now, it constantly revisited the old saying how to avoid pocket-related complications and design a nice pocket. In an article published in this issue, Enomoto et al.2 described a single-center retrospective study which included 76 patients with ICD implanted through axillary vein, 31 of whom had pocket located in the axillary region. During an average follow-up time of 4.9 ± 2.3 years, it was found that, as comparedwith those of the45patientswith conventional left anterior chest pocket, the lead parameters were similar, and there were no complications such as lead failure or pocket infections. Different from the previous case reports, this study had the longest follow-up time and the largest sample size to date, verified the feasibility and safety of the axillary pocket for large volume devices. The main novel points and research value of this study are as follows: