Pneumothorax as a complication of cardiac rhythm management devices implantation

Abstract

Introduction/Objective Pneumothorax is one of the most common complications of cardiac rhythm management (CRM) devices implantation. We aimed to assess the incidence of pneumothorax after implantation of these devices and to determine risk factors for this complication. Methods A retrospective, observational study included patients in whom CRM devices were implanted, pacing system was upgraded, or lead revision was performed during 2012 at the Pacemaker Center, Clinical Center of Serbia. We determined the connection between different variables, including sex, age, type of implanted device, prior history of chronic obstructive pulmonary disease, operator experience, venous access, the use of intravenous contrast during procedure, and the development of pneumothorax as the procedure-related complication, using multiple logistic regression. Results A total of 999 patients were included in this study. The patients' mean age was 68.1 ± 9.2 years; 665 (66.6%) patients were male. The incidence of pneumothorax was 1.8% and an invasive treatment of this complication was required in 13 (72.2%) patients. Pneumothorax was more frequent in women (B = -2.136, p = 0.015), in patients with age > 75 years (B = 4.315, p = 0.001), venous access with subclavian vein puncture (B = 2.672, p = 0.045), and use of intravenous contrast during procedure (B = 3.155, p = 0.007). Conclusion Pneumothorax is a relatively rare complication of CRM device implantation, and for reducing its incidence, cephalic vein cut-down should be preferred to subclavian or axillary vein puncture as venous access, axillary vein puncture should not be avoided when cephalic vein cannot be found or used, and in the case of difficult vein puncture, contrast venography should be done immediately, before risky punctures.

New developments, treatment options and possible complication in complex coronary artery disease, structural and congenital heart disease and heart failure

“…Finally, the same group of authors from the Pacemaker Center of the Clinical Center of Serbia reported the rate of pneumothorax, one of the most common complications of cardiac rhythm management devices, including antibradycardia pacemakers, implantable cardioverter defibrillators, and CRTs, during one year [5]. Among 999 patients, the rate of pneumothorax was 1.8% (incidence from the literature data is 0.66-5% [10]), and more often found in women, older patients, subclavian vein puncture, and the use of intravenous contrast during the procedure.…”

“…and devices for the treatment of coronary artery disease, structural heart diseases, including valvular and congenital heart disease, as well as heart failure, have changed the practice of modern cardiology. In this issue of the Serbian Archives of Medicine we present five articles on different novel techniques, devices, as well as complications of device implantation for the treatment of chronic total occlusion [1], aortic valve disease [2], patent ductus arteriosus [3], pacemaker systems upgrade [4], and finally critical analysis of the most common complications during the implantation of cardiac rhythm management devices [5].…”