# Air Entrapment in a Pacemaker Pocket in a Child

## TL;DR

A child with a pacemaker developed air entrapment in the device pocket, which can lead to pacemaker malfunction and requires close monitoring.

## Contribution

This paper reports a rare case of air entrapment in a pacemaker pocket in a child and highlights the importance of early detection.

## Key findings

- Air entrapment in the pacemaker pocket is a rare but serious complication in children.
- The complication can lead to pacemaker malfunction and requires serial chest radiographs for monitoring.
- Early identification of air entrapment improves clinical outcomes.

## Abstract

What are the main findings?
Implantation of a pacemaker in children is associated with a risk of air entrapment in the pacemaker pocket.This complication increases the risk of pacemaker malfunction.

Implantation of a pacemaker in children is associated with a risk of air entrapment in the pacemaker pocket.

This complication increases the risk of pacemaker malfunction.

What are the implications of the main findings?
Pacemaker implantation in children should be serially followed by chest radiographs.It is important to be aware of this potential unusual complication when considering precautions, diagnostic measures, and treatment options.

Pacemaker implantation in children should be serially followed by chest radiographs.

It is important to be aware of this potential unusual complication when considering precautions, diagnostic measures, and treatment options.

Background: Advances in pediatric electrophysiology have revolutionized cardiac care by offering patients treatments for increasingly complex cardiac rhythm and conduction disorders. However, despite these innovations, there are a number of potential complications that clinicians have to deal with. Case presentation: This clinical case study describes a rare complication in a child following pacemaker implantation, namely the appearance and accumulation of air in the pacemaker pocket. The child underwent multiple cardiac surgery for a complex congenital heart defect (CHD). Unfortunately, during surgical repair of a ventricular septal defect, the conduction pathways were disturbed. This caused second-degree atrioventricular block and required implantation of an epicardial pacemaker system. Heart block developed several days postoperatively and the child underwent a series of diagnostic tests and was successfully treated. Discussion: Pneumothorax and pneumomediastinum with air dissemination into the pacemaker pocket may develop postoperatively. But this a rare complication of pacemaker implantation, especially in children. This complication can cause pacemaker malfunction and be life-threatening. In the presented clinical case, the most likely cause was spontaneous pneumothorax expanding to the mediastinum and into the pacemaker pocket. Conclusions: Early identification of this complication will minimize the risk of pacemaker dysfunction and improve clinical outcomes.