Pneumomediastinum and right sided pneumothorax following dual chamber-ICD implantation.

A 64-year-old-male with ischemic cardiomyopathy and a severely reduced left ventricular ejection fraction underwent a left sided ICD implantation for primary prophylaxis. Given a history of sarcoidosis and bifasicular block on ECG, a dual chamber device was placed in anticipation of progressive conduction disease. The patient returned 2 days after implantation with a right sided tension pneumothorax. A chest tube was immediately placed with hemodynamic and clinical improvement. CT chest revealed extrusion of the atrial lead through the right atrial appendage. The atrial lead was removed without incident.