Pacemaker-Associated Post-cardiac Injury Syndrome Presenting with Tamponade and Recurrent Pleural Effusion

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Pacemaker-associated post-cardiac injury syndrome (PCIS) presenting with impending cardiac tamponade and recurrent pleural effusion (n=1). Intervention: Pericardiocentesis, thoracentesis, colchicine, corticosteroids, and video-assisted thoracic surgery (VATS) with talc pleurodesis. Primary outcome: Resolution of recurrent pleural effusion and pericardial effusion.

Q: What does this research mean for the field?

Post-cardiac injury syndrome can manifest after pacemaker insertion with cardiac tamponade and steroid-refractory recurrent pleural effusion that can be resolved with talc pleurodesis. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Young Ju Lee; Mahmood Mubasher; Abir Zainal; Tausif Syed; Mouhand Mohamed; Matthew Ferrantino; Ryan Hoefen

doi:10.1177/1179547620965559

January 1, 2020Clinical Medicine Insights Case ReportsOpen Access

Pacemaker-Associated Post-cardiac Injury Syndrome Presenting with Tamponade and Recurrent Pleural Effusion

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Key result

VATS with talc pleurodesis resolves refractory recurrent pleural effusion in post-pacemaker post-cardiac injury syndrome.

n=1

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Why the study?

Post-cardiac injury syndrome is rarely reported following pacemaker insertion, with an estimated incidence of 1% to 2%.

Key Points

To describe a rare presentation of post-cardiac injury syndrome presenting with impending cardiac tamponade and steroid-refractory recurrent pleural effusions following permanent pacemaker implantation.
Documented the clinical evaluation and hospital course of a 62-year-old female who developed post-cardiac injury syndrome 8 weeks after permanent pacemaker placement.
Conducted diagnostic imaging, including transthoracic echocardiography and computed tomography angiography, alongside pacemaker lead interrogation and fluid cytology.
Administered medical therapies including colchicine and systemic corticosteroids, followed by invasive drainage and surgical intervention.
Emergency pericardiocentesis for impending tamponade successfully drained 500 ml of bloody fluid immediately and an additional 210 ml over 24 hours.
Subsequent recurrent left pleural effusion required thoracentesis with removal of 1 l of sterile, exudative fluid.
Pleural effusions recurred despite trials of corticosteroids, ultimately resolving following successful talc pleurodesis.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

1 female patient (aged 62 years) with hypothyroidism and osteopenia who developed post-cardiac injury syndrome complicated by impending cardiac tamponade and recurrent pleural effusions 8 weeks after permanent pacemaker implantation.

I

Intervention

Pacemaker insertion

O

Outcome

Post-cardiac injury syndrome (PCIS) presenting with tamponade and recurrent pleural effusion

This case highlights the need to consider post-cardiac injury syndrome as a possible etiology of recurrent pleural effusion following pacemaker insertion.

Limitations

Single patient case report
Normal pacemaker interrogation does not completely rule out lead micro-perforation

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Implication

Talc pleurodesis may resolve steroid-refractory effusions in post-pacemaker PCIS; hypothesis-generating and requires prospective confirmation before clinical adoption.

Abstract

Post-cardiac injury syndrome (PCIS) is presumed to be an immune-mediated process. It affects the pericardium and, to a lesser extent, the epicardium, myocardium, and pleura. It has been rarely reported following pacemaker insertion with an estimated incidence of 1% to 2%. We present the case of a 62-year-old female who developed PCIS 8 weeks following pacemaker insertion. She presented with impending cardiac tamponade requiring pericardiocentesis; recurrent pleural effusions subsequently complicated her condition. The pleural effusion recurred despite trials of steroids, eventually requiring talc pleurodesis. This case highlights the need to consider PCIS as a possible etiology of recurrent pleural effusion following pacemaker insertion.

Discussion

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Cite This Study

Lee et al. (2020) conducted a case report in Pacemaker-associated post-cardiac injury syndrome (PCIS) presenting with impending cardiac tamponade and recurrent pleural effusion (n=1). Pericardiocentesis, thoracentesis, colchicine, corticosteroids, and video-assisted thoracic surgery (VATS) with talc pleurodesis was evaluated on Resolution of recurrent pleural effusion and pericardial effusion. Video-assisted thoracic surgery with talc pleurodesis resolved steroid-refractory recurrent pleural effusion in a 62-year-old woman with post-pacemaker post-cardiac injury syndrome.

synapsesocial.com/papers/6a81c13e9022b29b18a1eb20 https://doi.org/10.1177/1179547620965559

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Pacemaker-Associated Post-cardiac Injury Syndrome Presenting with Tamponade and Recurrent Pleural Effusion

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Pacemaker-Associated Post-cardiac Injury Syndrome Presenting with Tamponade and Recurrent Pleural Effusion

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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