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

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 xrays 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 & PLUSMN; 3.9 vs 2.7 & PLUSMN; 2.9 days, P = 0.04), but fewer chest x-rays (1.9 & PLUSMN; 0.7 vs 4.1 & PLUSMN; 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.