# Supraventricular Tachycardia Induced by Mediastinal Irritation From a Chest Tube: A Rare and Overlooked Complication

## TL;DR

A chest tube near the mediastinum can cause supraventricular tachycardia, a rare complication that requires careful management.

## Contribution

This paper reports a rare case of SVT caused by mediastinal irritation from a chest tube, emphasizing the importance of proper tube placement.

## Key findings

- A left-sided chest tube near the mediastinum was linked to the development of supraventricular tachycardia.
- The arrhythmia was successfully treated with adenosine and verapamil.
- The case underscores the need for early recognition of mechanical irritation as a cause of arrhythmia.

## Abstract

Supraventricular tachycardia (SVT) is commonly associated with intrinsic cardiac or metabolic causes. However, mechanical irritation of mediastinal structures from thoracic intervention is an uncommon and often overlooked trigger. Irritation of the pericardium or nearby autonomic fibers can disrupt normal conduction pathways and provoke reentrant arrhythmias such as SVT.

We report a case of a 40-year-old male with diabetes mellitus who initially underwent right-sided intercostal (IC) tube insertion for a pneumothorax. Following accidental tube dislodgement, he developed recurrent pneumothorax and extensive subcutaneous emphysema, requiring multiple additional IC tubes. During the lung re-expansion phase, the patient developed SVT. Imaging revealed that a left-sided chest tube was near the mediastinum, suggesting mechanical irritation as the likely precipitating factor. The arrhythmia was managed successfully with intravenous adenosine, followed by a short course of oral verapamil for rhythm control.

This case highlights a rare but significant complication of chest tube insertion. Mechanical irritation of the mediastinum should be considered a potential cause of new-onset arrhythmia following thoracic interventions. Early recognition and proper tube positioning are essential to prevent adverse outcomes.