A Rare Case of Asystole Due to Exaggerated Vagal Tone Following Chest Tube Placement

Excessive vagal tone can lead to unstable bradyarrhythmias. We present the case of a 39-year-old otherwise healthy man who failed outpatient treatment for community-acquired pneumonia with oral antibiotics and underwent left-sided chest tube placement for empyema. After chest tube placement, the patient had a first-ever episode of syncope, which on telemetry coincided with a 16-second pause and asystole followed by the spontaneous recovery of sinus rhythm. Electrolytes and high-sensitivity troponin were within normal limits. The electrocardiogram (EKG) did not reveal any signs of ischemia. Eventually, the chest tube was removed after the drainage of pleural fluid, and the patient did not have any recurrence of arrhythmia or symptoms. He was discharged home after the completion of intravenous antibiotics.