Pacemaker system failure secondary to air entrapment within the pulse generator pocket. A complication of subclavian venipuncture for lead placement.

Air entrapment within the pulse generator pocket may produce pacemaker system malfunction if the anodal contract plate becomes insulated by the accumulation of air. Unipolar pulse generators are predisposed to this complication. We describe a pacemaker-dependent patient who, early after implantation, experienced pacemaker system failure as a complication of subclavian venipuncture. This patient had an unsuspected pneumothorax that progressed to subcutaneous air entrapment within the pulse generator pocket. Management of this previously unreported complication of subclavian venipuncture is rapid, noninvasive and effective. With the growing use of subclavian venipuncture technique for lead placement one should avoid the predisposing factors that can lead to subcutaneous air entrapment.