skip to main content

Post-CRT Implant Effusion — EECC MCQ

Instant feedback + full explanation. One question, done properly.

ModerateCardiac DevicesPost-CRT Implant EffusionEECC

A 62-year-old man with HFrEF and a newly implanted CRT-D presents 2 weeks post-implant with pleuritic chest pain and dyspnoea. CXR shows a moderate left-sided pleural effusion. He is afebrile with normal inflammatory markers. What is the likely diagnosis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Post-cardiac implantable device pericardial effusion or lead perforation — although pleural effusion post-CIED implant can result from LV lead perforation into the pericardial space or CS dissection; a CT or echo should assess for pericardial effusion/tamponade and lead position

New effusion shortly after CIED implantation should raise suspicion for procedural complications: (1) LV lead perforation through the coronary sinus into the pericardial space → haemopericardium → pericardial effusion ± tamponade; may present as pleuritic pain with pleural effusion (pericardial-pleural communication); (2) CS dissection during LV lead placement → pericardial extravasation; (3) subclavian vein thrombosis → PE (usually later); (4) pneumothorax (from subclavian access — usually immediate). Evaluation: (1) urgent echocardiography (assess pericardial effusion, RV compression, lead position); (2) CXR (lead position — LV lead should follow CS anatomy, not be in the LV cavity or pericardial space); (3) CT if echo is equivocal; (4) device interrogation (pacing thresholds — a very high LV lead threshold may indicate perforation or dislodgement). If lead perforation confirmed: urgent lead repositioning, pericardiocentesis if tamponade developing.

Reference: ESC (2021): Pacing Guidelines