Iatrogenic pneumothorax from pacemaker procedure.

Has anyone experienced an iatrogenic pneumothorax during a pacemaker implantation procedure? I just added “pneumothorax” to my vocabulary. It means I have a puncture hole in my lung from a doctor trying to thread a needle to find the vein (reportedly as big and wide as one’s little finger) that the pacemaker wires go through to reach my heart.

I’m told to assume the injury going to be okay, that the puncture wound is relatively small and will heal itself over. The air that escapes through the lung hole into my chest tissue will evidently just be absorbed or somehow disappear when the hole repairs itself. I apparently am not in too much danger of a collapsed lung.

I never in my wildest imagination conceived of this possibility, though I do understand all invasive procedures carry risks. I am learning that is truer in teaching hospitals. I have every reason to believe it was the Fellow not the Attending who punctured my lung during this “routine” procedure. So much for my assiduously finding the top EP in my area to trust to give me expert care.

I spent an extra day in the hospital with one X-ray after another as they kept measuring the pneumothorax to see if it grew or shrank. The lung hole was almost big enough (over 3cm) to require another invasive procedure of cutting a slit through my ribs! to reach and aspirate the air bubble, which could cause my lung to collapse if it got too big. It was not small enough (2cm) to just send me home. I was in limbo.

I contacted my PCP and said, “Help!” I needed information. This was all new to me. Reading between the lines of her messaging, I got the clear notion that I should go home and let it heal by itself given I was asymptomatic : no pain, no breathing issues. In asymptomatic relatively small iatrogenic pneumothoraxes, not inserting a tube was “non-inferior” to inserting a tube, according to an article she just happened to cite. Spontanteous pneumothoraxes rising from lung disease are a whole different matter. My lungs are (were?) healthy. My fast and intense research online led me to the same conclusion: no more invasive procedures!

So I’m home and ready to wash my hands of interventional cardiology, just glad I escaped the hospital alive.

The good news is that already, after one week, I see signs of feeling better with the pacemaker, especially in the lifting of fatigue and lightheadedness. I feel pretty much like I felt after a successful cardioversion, which was “I feel more like myself again, I feel pretty good.” So that’s the good part. I’m grateful for the pacemaker and believe it will bring to an end the nightmarish merry-go-round at the Afib Circus of drugs, cardioversions, and ablations. We’ll see, I guess.

I’m delightedly done with drugs now that I have a Watchman and a pacemaker. I hope now I’m done with interventional cardiology!!

I can deal with the techs who regulate the pacemaker, but no more invasive procedures (3 to date), CV’s (I’ve had 9), or debilitating drugs (I’ve had tons). I’ve had it.

Has anyone had a similar experience?An iatrogenic pneumothorax from a pacemaker procedure? This is all new to me.

To sum up, I’m home with a hole in my lung which is in the never-never land of not big enough to do anything about and not small enough to be considered of little risk. It is presumably healing. There won’t be another X-ray to measure its size for another two weeks. I feel like I’m in the middle of a crap shoot.

[Ilovedogs12]

Hi,I can understand how worrying and upsetting this is for you. It's not what you expected, it's a shock.

Try to be positive. They will have seen this before and have experience of it. They have said it will heal itself so focus on that. And you have no pain or breathing problems which is good.

I have no experience of this so I can't offer any answer to your question.

I had a thorax scan recently, the doctor arranged it because I have been coughing since I had covid last year, and I expected it to show no problems.

My right lung showed permanent lung damage, a partial collapse and a node 10cms long. 10cms is almost 4"! I rang the scanning department to check, I thought they'd put cms by mistake and it should have been mms but it was correct. I am waiting for an appointment with a respiratory consultant but it's a long wait apparently.

Heart and lungs - we don't want problems with either do we?

It's great that your pacemaker is a success! I hope you get good news at your next x-ray and that it's soon healed.

[Hidden in reply to Ilovedogs12]

Thanks so much for responding. Please see my response to baba. It’s what I’d write to each of the wonderful people who have responded to my post. ❤️

[Buffafly]

A couple of months after my one and only ablation for AF and Flutter I was admitted to hospital with a severe ‘mystery infection’. While I was having tests a dr came in and said ‘never mind the infection, what I’m worried about is that you have a small pneumothorax’. Well I felt as if I was dying and wasn’t interested in explanations! Then it turned out I had a bowel abscess which caused a bit of a panic and no one ever mentioned the pneumothorax again except on my discharge letter. So either it happened during the ablation under GA, which is possible, or as a result of the filthy cough I developed a couple of weeks after the ablation, or maybe……but I’m with you, firmly refused any further ablations although the AF returned. I would have a pacemaker if offered though because of so many reports of improved QOL and I hope you continue to do well ❤️‍🩹

[Ilovedogs12 in reply to Buffafly]

So yours must have self healed without causing you any bother. That's very reassuring for Sweetmelody.

[Hidden in reply to Buffafly]

Thanks so much for responding. Please see my response to baba. It’s what I’d write to each of the wonderful people who have responded to my post. ❤️

[JaneFinn]

I’m so sorry to hear about the pnneumothorax, what a shock and how gutting. I’d never thought about the added risks of a teaching hospital and not being your experienced and carefully chosen EP doing the procedures. Seems all wrong, somehow…

I do hope you heal up quickly and that your natural positivity can carry you through the next 2 weeks til the X-ray, and that it will prove all to be ok 🙏🏻 I’m so glad to hear that the other outcomes of the procedures have been so good - that’s great news! Onwards and upwards from here, I think. And no more interventions or nasty meds! Jx

[Hidden in reply to JaneFinn]

Thanks so much for responding. Please see my response to baba. It’s what I’d write to each of the wonderful people who have responded to my post. ❤️

[JaneFinn in reply to Hidden]

I agree, it’s the lack of openness, acknowledgment, empathy and (to be frank) humanity in the way they’ve responded to the problem and behaved to you that is so shocking and most upsetting. I’d feel the same. 😢 xxx

[Hidden in reply to JaneFinn]

👍 You nailed it!

[Ilovedogs12]

I'm with you, I thought teaching hospitals would be the best but this has opened my eyes.

[Buffafly in reply to Ilovedogs12]

You can get a student doing your procedure under supervision anywhere. I realised a few minutes into my cataract operation that it was being performed by a student surgeon, which I hadn’t been warned about. I think there’s a waiver somewhere in the form you sign but do we read every word of those?

[Ilovedogs12 in reply to Buffafly]

That's a revelation. I didn't think students would be allowed to actually perform procedures. Assist yes, but you want to be confident that you're in safe hands. Can being ill get any more frightening?

[Buffafly in reply to Ilovedogs12]

When I say student, I mean a doctor training to be an ophthalmic surgeon. All surgeons have to practice on somebody! Although I’ve seen TV adverts about the wonders of AI allowing virtual operations. My nightmare is a robot dentist 😱

[frazeej in reply to Ilovedogs12]

If students never perform any procedures, how do they stop being students?

[Hidden in reply to Ilovedogs12]

Thanks so much for responding. Please see my response to baba. It’s what I’d write to each of the wonderful people who have responded to my post. ❤️

[baba]

Sorry you have this complication, I hope it heals without further intervention.

Every experienced EP and surgeon did their first operation on someone!

[Hidden in reply to baba]

That’s not what bothers me. It is the lack of candidness, honesty, openness, acknowledgement, accountability. I feel like I’ve been jerked around. If the doctors had just said “This is what happened and we’re very sorry,” I would be understanding (still am) and graciously accepting of the apology. I know the Fellow in particular was tellingly rattled and in anguish—but without admitting responsibility. Fear of legal action, I’m sure. I, like most patients I believe, would be accepting of the truth. There was no negligence. It was an unfortunate accident, but we all know going in that invasive procedures carry risks.

What upsets me most is the feeling of being jerked around, “played.” No one was upfront with me about how this happened and by whom, no matter how many pressing questions I asked. I was told in essence, to paraphrase, “ Gosh, we’re not sure when or by whom or how this happened because BOTH of us were messing around with the needle.”

Here’s my analogy. A car runs into a tree. Both of the people who were in the car are standing outside the car when the cop arrives. The cop asks, “Who was driving at the time of the accident? Who had his hands on the wheel?” The answer, “Gosh, officer, we don’t know. Both of us were driving.”

Would you buy into that?

I’m angrier about the subterfuge than I am about the injury. I’m actually not angry about the injury: stuff happens. I’m angry about the lack of frankness, accountability, and followup attentiveness to how this episode has affected me as a “whole person.” Their post-injury behavior has caused a loss of trust and respect for my doctors, and a loss of trust can negatively affect healing. It has caused psychological/emotional fallout that the EP people apparently believe is none of their concern. I’m just a body with an ID number. Nobody in EP has checked in with me to see how I’m doing (I find that hard to believe), and I’m sure as hell not going to go begging at their door for a little empathy and attentive care. I feel pushed aside, almost a pariah. No one in EP has followed through on making the appointment the Attending told me he wanted earlier than scheduled to check on and adjust the pacemaker. When I brought that up, I was told to make the appointment myself. I don’t even know who to make that appointment with!

At any rate, I’m washing my hands of them. I’ll deal with the pacemaker technicians, but that’s about it. I’ve turned to my PCP for care of the pneumothorax. I’ve turned to my therapist to help with the emotional fallout. I’m so lucky that I have a wide circle of friends and supporters to help me. I’m a widow with no family near me geographically.

I do not have nor never had any intention of pursuing any sort of legal action. It was an accident and I see no negligence. Negligence would be not reporting the injury or not detecting it until it caused serious consequences. I see no negligence, except in empathy, honesty, openness, accountability. When are doctors going to learn that straightforward honesty with patients is the right way to go? My stepdaughter tells me she read a study showing that malpractice suits went way down when doctors were simply open, honest, and apologetic.

Ah, and here’s the kicker. Because of the lung injury, they kept me in the hospital a second day. My insurance pre-approval was for only one night. I have now been informed that I was coded an Outpatient even though I was de facto an Inpatient due to an injury caused by the doctors. How’s that for Orwellian language!

Being coded an Outpatient (meaning I was only “under observation” and not being treated) means increased costs in co-pays for me. That means I get to pay more for my own iatrogenic injury!! If the injury had been serious enough to require another invasive procedure of a tube shoved through my rib cage (yuck!), I’d be coveted. But since they were able to send me home, I was classified as an Outpatient even though I was an Inpatient due to their error. What a freaking broken, Kafkaesque medical system!

Thanks to everyone who responded. I didn’t know I’d go on like this when I started my answer to be a, so I’m going to refer all of you kind and supportive people to this response. Thank you all. I need this forum to get my frustrations out among people who understand. Thank you, thank you.

[Franny50]

Holy cow! I wondered what had transpired with your P&A when you went silent.

I'm having mine done in a teaching hospital also, and I agree with you that seeking out the "best" and most highly sought after EP who teaches in a teaching hospital can lead to unwelcome consequences, apparently.

Also, cardiology practices are being gobbled up by private equity firms, like every other type of medical practice (including even veterinary practices) which has incentivized churning patients in and out the door or operating room quickly and cutting corners as much as possible. EP's hate it, PA's hate it, nurses hate it, but the Wall Street bros are raking in big money.

In my situation, the insurance company waded in at the last minute and denied me a CRT biventricular PM in favor of a (problematic?) dual lead because I have a good ejection fraction. I read there is a potential for future dissynchrony between the ventricles. But my EP will not appeal, so be it.

I am a 20+ year stage 4 cancer survivor, and have been taking supplements which research indicates bolster immunity, healing and suppress inflammation, despite the disdain and negative press from the medical establishment. But I can't provide links due to this site's resistance to allowing random links. If you have the time and inclination, check out research published over decades re: resveratrol, curcumin, quercetin, apigenin, astaxanthin, lutein, zeaxanthin zinc, vitamin C, taurine.

I am so sorry that this happened to you. Please give them hell if you deem it appropriate (lawyers?) and keep posting.

[Hidden in reply to Franny50]

Thanks so much for responding. Please see my response to baba. It’s what I’d write to each of the wonderful people who have responded to my post. ❤️

And also, I take lots of supplements, see a functional medicine practitioner, and eats lots of vegetables!

[Borderterriorist]

I had a pneumothorax in January as a result of broken ribs (got bucked off a horse) it all healed without a problem, breathing was my main problem as broken ribs are extremely painful so I was kept in hospital for 2 weeks as I got a bit of a chest infection. Pleased yours has healed without pain or any other problems, they usually do.

My daughter is a doctor, nearly got to consultant level but is still not quite there. She's an anaesthetist, her work involves doing lots of very difficult procedures some of which if they go wrong can be life threatening. There is a saying in medicine, see one, do one, teach one! That's how doctors learn their skills. When my daughter visited me the day after the accident she looked at my notes and asked me about my pain levels, frankly I was in agony, apart from the broken ribs and pneumothorax I also had a massive haematoma down my left side. The medical team arrived and she politely introduced herself and asked if they thought I might be a good candidate for a SER nerve block, they said yes but they didn't have many anaesthetists who were trained to do one but they'd consider it.

The next morning an anaesthetist came to see me, said he'd seen one done but had never done one himself and there was no one to supervise, was I prepared to let him do it. I said yes and he then said would it be OK for a few other anaesthetists to watch. I said yes. He did it, I was in considerably less pain and about 6 other anaesthetists were able to offer the procedure. Every hospital is a teaching hospital, every doctor below consultant level is being trained.

Doctors have to learn. My pacemaker was put it under the supervision of the consultant, I knew the doctor was being trained because of the comments being made and he had to remove several stitches because they weren't quite correct but new doctors have to learn and learning involves making mistakes, that is a fact. If you want a consultant to do your procedure I'm afraid you need to go private

[Hidden in reply to Borderterriorist]

I’m not upset about the fact that the Fellow was involved in the procedure. Of course doctors need to learn. I knew he would be involved, but I trusted the Attending to be on top of things.

What upsets me is the lack of transparency and accountability. I want to hear the Fellow say he erred (if indeed he was the one), he’s deeply sorry, he and the Attending are using the accident to learn from so as to mitigate the possibility of it happening again, that the errant events of the procedure are under review and providing good training, or that he understands exactly what happened and will not let it happen again to the best of his ability.

His courageously being upfront with me would have been salutary for both of us. Basically they said to me, “Gee, we don’t know how this happened because both of us were doing a bunch of stuff when it happened.” That is not a responsible answer to my question. And it ticks me off.

Your experience was different. You experienced total transparency and were given the choice to agree to the procedure and who performed it. No smoke and mirrors. No obfuscating. That’s healthy in medical relationships between doctor and patient.

I’m glad things worked out well for you, but it does sound like it was a painful experience. You must be very proud of your daughter.

[Borderterriorist in reply to Hidden]

After sending my message I realised you are in the US so things might be different there. Yes very proud of my daughter and I think it has changed the way I view doctors and medicine as I see it from both sides now. I was only given transparency because the doctor doing the procedure would not have been signed off and there was no supervising doctor but I was in so much pain and so sick from the oral painkillers that frankly I'd probably have let anyone have a go! With regard to the fitting of my pacemaker, I wasn't asked if I minded a having a junior doctor (UK description of any doctor who is not a consultant) do it. If I had I would have said yes but it's normal practice here in the UK for Juniors to learn under supervision initially until they are assessed as competent, then they do things on their own and train other doctors. A Pneomothorax is a recognised potential complication of having a pacemaker fitted about 1% of patients have one. I don't know how they do it in the US but certainly I was told of the various problems that could occur before I signed the consent form, no procedure is risk free. Hopefully you have healed well without an infection or blood clot and feeling better for it, I know my pacemaker is looking after me and have reason to be very grateful for it's presence although it is not especially comfortable as it can rub against the collar bone and shoulder. C'est La Vie! I hope you stay well.

[Hidden in reply to Borderterriorist]

What a lovely response. Thank you.

[opal11uk]

Thats dreadfully bad luck, certainly not a normal outcome I'm sure but always remembering that with any procedure we put ourselves in the hands of others and thereby potential danger, Ive had a Pacemaker now for almost 10 years and it has been a blessing in my life, ive got a husband in his 80's who had an undisclosed Pneumothorax only discovered when he had a physical check up in his late teens (playing football/kick to the chest apparently) , he had no treatment other than rest and he was fine so, get plenty of rest and take care of yourself and hopefully all will recover on its own, if not then back to the medics.

[Hidden in reply to opal11uk]

I’m resting (which is good but not part of my usual skill set) and doing my breathing exercises with the spirometer. All will be well with my lung. I’m still thrilled to have the pacemaker and Watchman. I’m not so thrilled by the obfuscation and lack of accountability by my providers, but I’m working on that. I’m speaking up, and so far it appears I’m being heard. That’s good, too!

A pacemaker being “a blessing” in your life. Music to my ears! Thanks!

[Blearyeyed]

So sorry I will be keeping you in my thoughts.It's such a shame that you have this hanging over you for a little while when you would really want to be celebrating that the pacemaker seems to be successfully doing its job.

Take care and I hope it heals smoothly soon , Bee

[Hidden in reply to Blearyeyed]

I’m taking steps to resolve the situation with my doctors that will allow me to put this experience behind me. No, this isn’t what I should be doing instead of purely celebrating my new pacemaker as I had expected to do, but I need to achieve closure by hearing acknowledgment, accountability, and apology. I’m halfway there. I am being heard. There’s something in me that has to speak up when I see something amiss. That helps me be at peace with myself. Thanks for your good wishes.

[Snowgirl65]

Good grief, what a story. I share your concerns -- and yours are (hopefully were) much worse than mine were, when my first EP nicked my phrenic nerve during my first ablation, causing my diaphragm to go zombie for a full minute. Kept me in the hospital an additional day to make sure all was well -- it was. Keeping fingers crossed for you that your lung will indeed heal as it should, and congratulations that the pacemaker is properly doing its thing!

[Hidden in reply to Snowgirl65]

Thanks so much! Sharing and empathy plus optimism go a long way!!

[frazeej]

A small pneumothorax such as you describe is not really a serious issue. Not that I don’t consider ANY invasive procedure serious, worse things could have happened!

JimF

[Hidden]

Agree. Heck, with a large pneumothorax I could have died.

But I was there when the doctors described the possible need of cutting a hole in my side under my armpit to put a tube through my ribs and up to the pneumothorax. And perhaps having to put a needle through my chest to aspirate it. Having those prospects explained to me was not fun. At the beginning, it was 50-50 whether or not I was going to have to undergo another invasive procedure.

I did not know that it was not a serious issue at that time. Now that’s how I look at it because I’m getting better, but I’ve also learned that having one iatrogenic pneumothorax makes me vulnerable to a recurrence, though not as vulnerable as someone with a spontaneous pneumothorax. One study shows that the chances of recurrence of an iatrogenic pneumothorax is 1 in 3. Yikes! There are consequences. I take those odds seriously. It would be a mistake for me to minimize the injury. Or let the medical team brush it under the rug.