• Implantable cardioverter defibrillator
• pacemakers

Over the past two decades cardiology has become an increasingly interventional speciality. Pacemaker implantation is now a common practice and is undertaken in most UK hospitals. Advances in pacing technology and an increasing adult congenital population have seen cardiac rhythm device implantation in younger patients. The need for a cosmetically acceptable scar is increasingly important in this population who will require several box changes within their lifetime. There is also a trend towards ‘hybrid’ procedures in surgical theatres or hybrid cardiac catheter laboratoriess. Surgical principles and basic surgical skills have an increasing relevance and importance for cardiology trainees, but despite this very few cardiologists receive any formal surgical training.

Pacemaker pocket infection is a serious complication, with rates between 1% and 5% reported. This can lead to life-threatening infections (triple the risk of death) such as endocarditis and septicaemia and the need for potentially complex repeat procedures with associated risk to the patient.1–6 The average economic cost of device infection treatment has been estimated at £34 000 per patient.7 Pocket haematoma is a frequent early complication after device implantation, with quoted rates of approximately 5%.8 This accounts for 17% of early re-operations and contributes to patient morbidity and prolonged hospitalisation.9 10 It is estimated that 60% of all surgical site …