Public Health and Epidemiology: Open Access
Exploring Contra-lateral Pneumothorax Following Pacemaker Placement: A Comprehensive Systematic Review of Case Reports
Abstract
Haseeb Khan Tareen
Objective: Contra-lateral pneumothorax following pacemaker placement is a rare but clinically significant complication, with sparse documentation in the existing literature. This review aims to comprehensively investigate this phenomenon, focusing on risk factors, diverse clinical presentations, diagnostic challenges, and effective management strategies.
Methods: We conducted a systematic literature search and data extraction from PubMed, Cochrane, Science Direct, and Google Scholar following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Results: Our review identified 28 cases of contra-lateral pneumothorax (CPTX) following pacemaker or implantable cardioverter-defibrillator (ICD) placement. The mean age was 70.5 years, with a predominantly male demographic (71%). The interval between the procedure and the onset of CPTX ranged from as early as 2 hours to as late as 6 months post-procedure. The most common presentations were chest pain (52%) and shortness of breath (30%).
Risk factors were categorized into procedural and non-procedural factors. Procedural factors included active fixation of a helical screw-in lead 17/28 (60%), atrial appendage lead placement 9/28 (32%) followed by lateral atrial wall lead placement 4/28 (14%). In 18/28 cases (64.3%), the subclavian vein was used as the access site, dual-chamber pacemakers were used in 23/28 cases (82%). Non-procedural factors encompassed steroid use 7/28 (25%), the presence of a thin-walled or multilobed atrial appendage 4/28 (14%) and long-standing smoking and emphysema 2/28 (7%).
Chest X-rays 27/28 (96%) and CT imaging 23/28(82%) were performed in most of the cases. An echocardiogram was performed in 46% of cases. Chest tube placement was necessary in 18/28 (64.3%) cases, while the remaining 10 cases were managed conservatively without invasive intervention (35.7%).
Conclusion: Contra lateral Pneumothorax is a rare but significant complication of cardiac implantable electronic device (CIED) placement. Key risk factors include the access site, lead placement location, pacemaker type, and steroid use. Management should be individualized based on symptom severity, ranging from conservative approach to invasive interventions such as chest tube placement. Special cautions are advised during active fixation lead screwing and when placing leads in the trial appendage, as these techniques were associated with an increased incidence of pneumothorax in our study.