Pulmonary Air Embolism During Insertion of a Permanent Transvenous Cardiac Pacemaker

In two patients pulmonary air embolism was a complication of the implantation of a permanent transvenous cardiac pacemaker. One of these patients, in whom air embolism was documented by cinefluorograms, is described in detail. Cinefluorograms demonstrated air in the right ventricle and main pulmonary artery with clear visualization of the opening and closing of the pulmonary valve. Both patients were treated conservatively by use of the left lateral decubitus position and administration of oxygen. The pathophysiology, hazards, and therapy of this complication are reviewed. Massive pulmonary air embolism is potentially fatal, and special care with regard to insertion of the electrode catheter should be taken in order to prevent it.