Predictors, Morbidity, and Costs Associated with Pneumothorax during Electronic Cardiac Device Implantation

John Kotter, Georges Lolay, Richard Charnigo, Steve Leung, Christopher Mckibbin, Matthew Sousa, Luis Jimenez, John Gurley, Luigi Di Biase, Andrea Natale, Susan Smyth, Yousef Darrat, Gustavo Morales, Claude S. Elayi

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Background: Pneumothorax (PTX) is a major cause of morbidity associated with cardiac implantable electronic devices (CIEDs). We sought to evaluate predictors of PTX at our centers during CIED implantations, including the venous access technique utilized, as well as to determine morbidity and costs associated with PTX. Methods: We reviewed records of all patients undergoing cardiac device implant or revision with new venous access at our institutions between 2008 and 2014. Common demographic and procedure characteristics were collected including age, sex, body mass index (BMI), comorbidities, and method of venous access (axillary vein vs classic proximal subclavian vein technique). Results: We identified 1,264 patients who met criteria for our analysis, with a total of 21 PTX cases during CIED implantation. The strongest predictor for PTX was the venous access strategy: 0 of 385 (0%) patients with axillary vein approach versus 21 of 879 (2.4%) with traditional subclavian vein approach, P = 0.0006. Additional predictors of PTX included advanced age, female sex, low BMI, and a new device implant (vs device upgrade). The occurrence of PTX was associated with increased length of stay: 3.0 days (median; interquartile range [IQR] 3) versus 1.0 day (median; IQR: 1), P = 0.0001, with a cost increase of 361.4%. Conclusion: An axillary vein vascular access strategy was associated with greatly reduced risk of iatrogenic PTX versus the traditional subclavian approach for CIED placement. Similarly, device upgrade with patent vascular access carried less risk of PTX compared to new device implantation. PTX occurrence significantly prolonged hospitalization and increased costs.

Original languageEnglish
Pages (from-to)985-991
Number of pages7
JournalPACE - Pacing and Clinical Electrophysiology
Issue number9
StatePublished - Sep 1 2016

Bibliographical note

Publisher Copyright:
© 2016 Wiley Periodicals, Inc.

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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