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Pneumopericardium and pneumothorax after permanent pacemaker implantation
Clifford C Sebastian1, Wen-Chih Wu, Mark Shafer
1Division of Cardiology, Providence VA Medical Center, Brown Medical School, Providence, Rhode Island 02908, USA.
Pacing and Clinical Electrophysiology : PACE
|May 5, 2005
Summary
A pacemaker lead caused a patient with chronic obstructive pulmonary disease (COPD) to develop a pneumothorax and pneumopericardium. Chest tube placement resolved these complications without lead removal.
Area of Science:
- Cardiology
- Thoracic Surgery
- Medical Imaging
Background:
- Dual-chamber pacemaker implantation is a common procedure for managing bradyarrhythmias.
- Complications, though rare, can occur, necessitating prompt diagnosis and management.
- Chronic obstructive pulmonary disease (COPD) may present unique challenges in pacemaker recipients.
Observation:
- A patient with COPD experienced discomfort two days post-pacemaker implantation.
- Computed tomography (CT) revealed right pneumothorax and pneumopericardium.
- Three-dimensional CT reconstruction identified the atrial lead protruding into the pleural space.
Findings:
- The protruding atrial lead is suspected to have ruptured a pulmonary bulla, leading to pneumothorax.
- A subsequent pleuro-pericardial communication allowed air to enter the pericardial sac, causing pneumopericardium.
- Active-fixation leads were used without immediate signs of complication.
Implications:
- This case highlights a rare but serious complication of pacemaker implantation.
- Non-invasive imaging, particularly CT with 3D reconstruction, is crucial for diagnosing lead malposition.
- Conservative management with chest tube placement can be effective, potentially avoiding lead extraction.