The Natural History and Treatment of Cardiac Implantable Electronic Device Associated Pneumothorax—A 10-Year Single-Centre Experience

Abstract

Background Pneumothorax is a common complication of cardiac implantable electronic device (CIED) procedures. There is a paucity of data on the natural history and management of a CIED-associated pneumothorax. Methods This is a single-centre retrospective study of all consecutive patients with a CIED-associated pneumothorax between March 2010 and March 2020. Pneumothorax size was determined on all chest x-rays after device implantation and before chest tube insertion (if placed). Changes in pneumothorax size on serial chest x-rays were reported. Clinical outcomes in patients with a severe-sized pneumothorax treated with a chest tube were compared with those treated conservatively. Results A total of 86 CIED-associated pneumothoraxes were identified, with 55 (63.9%) patients having a pneumothorax severe in size. Thirty-seven patients with a severe pneumothorax received a chest tube, whereas 18 were managed conservatively. Chest tube use was associated with a higher rate of admission to hospital (100% vs 63%, P = 0.02) for patients undergoing outpatient procedure, longer length of stay (6.3 ± 3.9 vs 2.7 ± 2.9 days, P = 0.04), but fewer chest x-rays (1.9 ± 0.7 vs 4.1 ± 2.5, P = 0.002). Conclusion An initial strategy of conservative management of a CIED-associated pneumothorax in select patients may be feasible and safe.

Caudal fluoroscopic guidance for the insertion of transvenous pacing leads

“…Caudal imaging may also allow for rationalization in routine use of CXR following CIED insertion. In a recent review of the yield of CXR after CIED insertion, pneumothoraces were found to occur in 1.9% cases 21 . Given the markedly lower incidence of pneumothorax associated with caudal imaging in our study, it may be suitable to consider a more tailored approach to post‐procedural CXR, for instance only in the setting of operator‐reported access challenges or patient‐reported symptoms.…”

“…In a recent review of the yield of CXR after CIED insertion, pneumothoraces were found to occur in 1.9% cases. 21 Given the markedly lower incidence of pneumothorax associated with caudal imaging in our study, it may be suitable to consider a more tailored approach to post-procedural CXR, for instance only in the setting of operator-reported access challenges or patient-reported symptoms. One limitation of the caudal fluoroscopic (and other oblique) view is the potential for increased radiation scatter which results in greater radiation exposure to the proceduralist.…”

Safety and efficacy of vacuum bottle plus catheter for drainage of iatrogenic pneumothorax

“…A similar result was reported by Faruqi et al, and the mean pain scores for simple aspiration and intercostal tube drainage were 1.6 and 4.0 respectively [ 17 ]. Moreover, the lack of indwelling catheter not only alleviated the irritable sensation that occurred owning to the presence of a foreign body object inside the body, which enabled patients to mobilize freely without limitation or fear of tube dislodgement, but also reduced the clinical burden of tube care on the nursing stuff and the medical costs [ 23 ]. Finally, no complication occurred in patients who underwent vacuum bottle plus non-tunneled catheter drainage in this study.…”

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

“…A patient can manifest signs and symptoms during the procedure or up to 72 hours after implantation ( 20 ). Every patient should receive a chest x-ray within 4 h post-procedure ( 30 ). Patients discharged from the hospital shortly after outpatient procedures should remain in contact with the CIED center ( 17 ).…”