Bilateral Pneumothorax Complicating Pacemaker Implantation, due to Puncture of the Left Subclavian Vein and Electrode Perforation of the Right Atrium

Olesen, Line Lisbeth

doi:10.7759/cureus.11302

Cited by 4 publications

(11 citation statements)

References 18 publications

(67 reference statements)

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“…As a result, these active fixation leads should be implanted cautiously. Anatomic variations, such as multilobed or a thin-walled atrial appendage, fatty infiltration of the myocardium due to myotonic dystrophy, ischemic and dilated cardiomyopathy, are variables that increase the likelihood of atrial perforation ( 10 , 11 , 13 , 15 , 20 , 23 – 29 ).…”

Section: Discussionmentioning

confidence: 99%

“…In concerning cases, fluoroscopy, chest CT with three-dimensional reconstruction, and echocardiography assist in diagnosing lead perforation ( 13 , 31 ); however, they are not as sensitive for tiny perforation ( 15 , 19 , 23 , 32 ). ECG-gated high-resolution CT (HRCT) remains the diagnostic gold standard although the perforation may be over-diagnosed ( 19 , 25 , 27 ).…”

Section: Discussionmentioning

confidence: 99%

“…High flow (10 L) 100% nasal oxygen, which theoretically accelerates air absorption, is generally recommended as the first step despite conflicting evidence suggesting that it has probably no effect on large pneumothoraces ( 13 , 37 , 38 ). A clinically stable patient with a small pneumothorax (<20%) can be observed since it may resolve on its own ( 12 , 36 ).…”

Section: Discussionmentioning

confidence: 99%

“…Patients with a large (>20%) pneumothorax or those presenting moderate-to-severe symptoms should be treated with a chest tube (12–16 French) for at least 24 h ( 11 – 13 , 36 ). If the pneumothorax improves, the absence of an air leak should be confirmed before the chest tube is removed ( 36 ).…”

Section: Discussionmentioning

confidence: 99%

“…Ipsilateral pneumothorax is commonly caused by needle penetration of the pleura during venous access (Figure 2) (5, 10,[12][13][14]. Concurrent pneumopericardium and pneumomediastinum can occur when the leaking air passes through the lung parenchyma along the perivascular sheaths to the hilum and the mediastinum (15, 16).…”

Section: Mechanisms Of Ipsilateral/contralateral Pneumothorax With Co...mentioning

confidence: 99%

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Case report: A rare complication after the implantation of a cardiac implantable electronic device: Contralateral pneumothorax with pneumopericardium and pneumomediastinum

Chen

2022

Front. Cardiovasc. Med.

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Cardiac implantable electronic devices (CIED) including pacemakers (PM), implantable cardioverter defibrillators (ICD), and cardiac resynchronized therapy (CRT) have become the mainstay of therapy for many cardiac conditions, consequently drawing attention to the risks and benefits of these procedures. Although CIED implantation is usually a safe procedure, pneumothorax remains an important complication and may contribute to increased morbidity, mortality, length of stay, and hospital costs. On the other hand, pneumopericardium and pneumomediastinum are rare but potentially fatal complications. Accordingly, a high degree of awareness about these complications is important. Pneumothorax almost always occurs on the ipsilateral side of implantation. The development of contralateral pneumothorax is uncommon and may be undetected on an initial chest radiograph. Contralateral pneumothorax with concurrent pneumopericardium and pneumomediastinum is much rarer. We describe a rare case of concurrent right-sided pneumothorax with pneumopericardium and pneumomediastinum after left-sided pacemaker implantation and highlight the risk factors, management, and possible ways to prevent the complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Mechanisms Of Ipsilateral/contralateral Pneumothorax With Co...mentioning

confidence: 99%

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Case report: A rare complication after the implantation of a cardiac implantable electronic device: Contralateral pneumothorax with pneumopericardium and pneumomediastinum

Chen

2022

Front. Cardiovasc. Med.

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Safety of Venography-Guided Extrathoracic Vein Puncture to Prevent Pneumothorax in Pacemaker Implantation

Topaloğlu

2023

Haydarpasa Numune Med J

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Introduction: Pacemaker implantation is routinely and widely used around the world for a variety of heart conditions. The use of venography guidance is very important for the operator at the puncture site and prevent complications such as pneumothorax. The aim of this study is to determine the effect of venography in preventing complications and to compare the rate of pneumothorax between patients operated with and without venography guidance. Methods: A total of 539 consecutive patients who had a pacemaker implanted in our clinic between 2012 and 2022 were included in this study. Pacemaker type according to the number of leads used, diagnosis for pacemaker implantation, patient age, gender, concomitant chronic obstructive pulmonary disease (COPD), presence of defibrillator battery and lead, venography guidance were evaluated and their contribution to the complication of pneumothorax was analyzed. Results: The incidence of pneumothorax development was found to be 1.3% in our study. Venography guidance was found to be significantly protective against pneumothorax, as the patient group that developed pneumothorax consisted of patients who did not undergo venography at a high rate. It was determined that in the patient group that developed pneumothorax, there was a high percentage of patients between the ages of 18-65, of female gender, without concomitant COPD, with 2 leads inserted and with implantable cardioverter defibrillator (ICD) implantation (single/double leads). Our study revealed that routine venography in pacemaker implantation is an effective method to protect patients from pneumothorax as well as lead fracture. Discussion and Conclusion: Our study revealed that routine venography during pacemaker implantation is an effective method to protect patients from pneumothorax. Since blind puncture of venous structures increases the risk of complications, venography guidance can be used routinely in pacemaker implantation.

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Atrial lead perforation early after device implantation—a case report and literature review

Wang,

Yuan,

et al. 2024

Front. Surg.

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We report three patients with screw-in lead perforation in the right atrial free wall not long after device implantation. All the patients complained of intermittent stabbing chest pain associated with deep breathing during the implantation. The “dry” epicardial puncture was utilized to avoid hemopericardium during lead extraction in the first case. The atrial electrode was repositioned in all cases and replaced by a new passive fixation lead in two patients with resolution of the pneumothorax or pericardial effusion. A literature review of 50 reported cases of atrial lead perforation was added to the findings in our case report.

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Bilateral Pneumothorax Complicating Pacemaker Implantation, due to Puncture of the Left Subclavian Vein and Electrode Perforation of the Right Atrium

Cited by 4 publications

References 18 publications

Case report: A rare complication after the implantation of a cardiac implantable electronic device: Contralateral pneumothorax with pneumopericardium and pneumomediastinum

Case report: A rare complication after the implantation of a cardiac implantable electronic device: Contralateral pneumothorax with pneumopericardium and pneumomediastinum

Safety of Venography-Guided Extrathoracic Vein Puncture to Prevent Pneumothorax in Pacemaker Implantation

Atrial lead perforation early after device implantation—a case report and literature review

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