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Introduction Axillary and Subclavian venous access during implantation of permanent pacemakers (PPMs) are known to be associated with a small risk of pneumothoraxes. Post PPM implantation CXRs are very crucial in assessing for these potential pneumothoraxes. If these CXRs are done too early post procedure, there is a small risk of missing a pneumothorax due to slow accumulation of air in the chest cavity. However, longer durations before these post procedural CXRs are done may limit the number of procedures that can be done logistically. The European Heart Rhythm Association recommends post procedural CXRs within 24 hours. Most hospitals tend to do these CXRs between 4–6 hours post-procedure. At Sheffield Teaching Hospitals, these CXRs are electronically requested for 2 hours post procedure. There is paucity of data on the safety of shorter durations of post procedural CXRs. This project set out to determine the real-life timing of these post procedural CXRs as well as the safety of the practice.Methods A retrospective survey of electronic records for all pacemakers implanted in January and February 2024 at Sheffield Teaching Hospitals was undertaken. The clock commenced from the timing of the fluoroscopic pictures saved during Venous access. The clock stopped at the timing of the post procedural CXR. Patients who underwent Cephalic access were finally excluded from the analysis. Quantitative data analysis was done in Microsoft Excel and SPSS. Proportions, Medians, and non-parametrical statistical tests at 0.5% level of significance were used.Results A total of 130 patients had PPMs implanted. Ninety-seven (75%) of these were male while thirty-three (25%) were female. The median age for males was 74 years while that for females was 76 years. Majority of venous access was axillary (N=118) 91% in comparison to cephalic venous access (N =12) 9%. The overall median timing for post procedural CXRs was 3 hours 22 minutes ( figure 1).Abstract 4-019 Figure 1Timing of post permanent pacemaker CXRsAs shown in figure 2, post procedural CXRs over the weekend appeared to be done earlier (median 2 hours 41 minutes) than those done during the weekdays (Median 3 hours 50 minutes) (P< 0.001, Mann-Whitney U Test). No patient was re-admitted with a pneumothorax following a clear first post procedural CXR.Abstract 4-019 Figure 2Comparison of timing of post PPM CXRs on weekends and weekdaysConclusion Post procedural CXRs were done at 3 hours and 22 minutes from the timing of venous access during the study period. This timing of post procedural CXRs appears safe as there was no re-admission due to a missed pneumothorax.