Thomas Garry R, Kumar Sharath K, Turner Suzette, Moussa Fuad, Singh Sheldon M
Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
CJC Open. 2020 Oct 21;3(2):176-181. doi: 10.1016/j.cjco.2020.10.011. eCollection 2021 Feb.
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.
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.
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%, = 0.02) for patients undergoing outpatient procedure, longer length of stay (6.3 ± 3.9 vs 2.7 ± 2.9 days, = 0.04), but fewer chest x-rays (1.9 ± 0.7 vs 4.1 ± 2.5, = 0.002).
An initial strategy of conservative management of a CIED-associated pneumothorax in select patients may be feasible and safe.
气胸是心脏植入式电子设备（CIED）手术常见的并发症。关于CIED相关气胸的自然病史和管理的数据较少。
这是一项单中心回顾性研究，纳入了2010年3月至2020年3月期间所有连续发生CIED相关气胸的患者。在设备植入后和插入胸管（如果放置）之前，对所有胸部X光片进行气胸大小的测定。报告系列胸部X光片上气胸大小的变化。比较接受胸管治疗的严重气胸患者与保守治疗患者的临床结局。
共识别出86例CIED相关气胸，其中55例（63.9%）患者气胸严重。37例严重气胸患者接受了胸管治疗，而18例接受了保守治疗。对于门诊手术患者，使用胸管与更高的住院率（100%对63%，P = 0.02）、更长的住院时间（6.3±3.9天对2.7±2.9天，P = 0.04）相关，但胸部X光检查次数较少（1.9±0.7次对4.1±2.5次，P = 0.002）。
对部分患者CIED相关气胸采取初始保守治疗策略可能是可行且安全的。
