A Rare Case of Asystole Due to Exaggerated Vagal Tone Following Chest Tube Placement

TL;DR

A healthy man experienced a rare case of asystole after a chest tube was placed, likely due to an exaggerated vagal response.

Contribution

This case highlights a rare complication of chest tube placement linked to exaggerated vagal tone.

Findings

A 39-year-old man developed a 16-second pause and asystole following chest tube placement.

The arrhythmia resolved spontaneously after chest tube removal with no recurrence.

Electrolytes and cardiac markers were normal, ruling out other causes like ischemia.

Abstract

Excessive vagal tone can lead to unstable bradyarrhythmias. We present the case of a 39-year-old otherwise healthy man who failed outpatient treatment for community-acquired pneumonia with oral antibiotics and underwent left-sided chest tube placement for empyema. After chest tube placement, the patient had a first-ever episode of syncope, which on telemetry coincided with a 16-second pause and asystole followed by the spontaneous recovery of sinus rhythm. Electrolytes and high-sensitivity troponin were within normal limits. The electrocardiogram (EKG) did not reveal any signs of ischemia. Eventually, the chest tube was removed after the drainage of pleural fluid, and the patient did not have any recurrence of arrhythmia or symptoms. He was discharged home after the completion of intravenous antibiotics.

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