Air Entrapment in a Pacemaker Pocket in a Child

Advances in pediatric electrophysiology have revolutionized cardiac care by offering patients treatments for increasingly complex cardiac rhythm and conduction disorders. However, despite these innovations, there are a number of potential complications that clinicians have to deal with.

This clinical case study describes a rare complication in a child following pacemaker implantation, namely the appearance and accumulation of air in the pacemaker pocket. The child underwent multiple cardiac surgery for a complex congenital heart defect (CHD). Unfortunately, during surgical repair of a ventricular septal defect, the conduction pathways were disturbed. This caused second-degree atrioventricular block and required implantation of an epicardial pacemaker system. Heart block developed several days postoperatively and the child underwent a series of diagnostic tests and was successfully treated.

Pneumothorax and pneumomediastinum with air dissemination into the pacemaker pocket may develop postoperatively. But this a rare complication of pacemaker implantation, especially in children. This complication can cause pacemaker malfunction and be life-threatening. In the presented clinical case, the most likely cause was spontaneous pneumothorax expanding to the mediastinum and into the pacemaker pocket.

Early identification of this complication will minimize the risk of pacemaker dysfunction and improve clinical outcomes.