Chylothorax after cardiac resynchronization therapy-pacemaker implantation: A case report

The benefit of cardiac implantable devices such as cardiac resynchronization therapy pacemaker (CRT-P) has been widely demonstrated in a number of clinical trials, and it remains an important guideline-recommended therapy for the management of patients with symptomatic heart failure with reduced ejection fraction and electromechanical heart muscle dyssynchrony.1 Despite improved training, advanced techniques, and better experience, device implantation is not without complications. Cannulation of the left subclavian vein, particularly in the context of a stenotic or occluded subclavian vein, can potentially cause injury to the thoracic duct. Disruption of the thoracic duct, at any location along its course, can lead to chylothorax. Thoracic surgery is a major cause of iatrogenic chylothorax, but its incidence rate is relatively low. Other reported etiologies include chest radiation, lung biopsies, subclavian vein occlusion, and lymphangioleiomyomatosis.2 Chylothorax after cardiac implantable electronic device implantation is extremely rare, with a paucity of reported cases. Here, we present a case of recurrent chylothorax secondary to thoracic duct injury during an upgrade from a dual-chamber pacemaker to CRT-P.s