**Abstract**

In this review article, we described the common causes and approach for chest pain that happens after cardiac device implantation surgeries. We also describe the clinical features and appropriate treatment for them.

**Keywords:** CIED implant, chest pain, pericardial effusion, pneumothorax, erosion of device

## **1. Introduction**

Cardiac implantable electronic devices (CIED) are being implanted for more than 600,000 patients on a yearly basis [1]. These CIEDs include pacemakers, implantable cardioverter defibrillators, and cardiac resynchronization therapy devices [2]. These implantation surgeries are not without risk, as there are many potential complications that can occur either immediately or in a delayed setting [3–6]. Many of the complications could have a common presentation of chest pain, and depending on the etiology, morbidity, and mortality can vary widely [7]. The surgical process itself during the cardiac implantation device surgery can result in chest pain [8]. However, it is paramount to differentiate chest pain due to acute coronary syndrome (ACS) from non-ischemic causes. In the setting of a ventricular paced rhythm or left bundle branch block, this can be difficult with electrocardiography as the ST segments or T waves may hide or mimic ACS [9]. In this situation, the modified Sgarbossa criteria can be implemented to improve the diagnostic accuracy of electrocardiography in this patient population [10–12]. Hence, it is very important to identify the causes of chest pain after any cardiac implantation device surgery. In this chapter, we will discuss a practical approach to chest pain after cardiac implantation device surgery.
