Hamaya R, et al. - In a large series of patients undergoing atrial fibrillation (AF) ablation, the incidence, management, and outcomes of cardiac tamponade were retrospectively investigated. Findings reported that although the incidence of tamponade was infrequent, surgical backup is essential for performing AF ablation. A successful management of tamponade did not allow to overlook subsequent complications.

Methods

• Researchers analyzed a total of 5222 AF ablation procedures in 3483 patients between 2002 and 2016 under a heparin-bridge anticoagulation protocol.

Results

• The occurrence of cardiac tamponade was reported in 51 procedures/patients, and the reported incidence was 0.98% per procedure and 1.46% per patient and was noted during the procedure in 42 patients and in the ward in the remaining 9 patients.
• Findings demonstrated that no clinical factors were related to the occurrence, but it was lower during cryoballoon than radiofrequency ablation (P=0.025).
• In 44 (86.3%) patients, need for pericardiocentesis was recognized, and except for in 2 (3.9%) patients requiring subsequent emergent surgical repairs, the haemodynamic state stabilized after a total of 377 (260–530) mL of pericardial blood drainage.
• Data reported that the pericardial drain was successfully removed after a median of 1.0 (1.0–2.0) days.
• Results showed that anticoagulation therapy was restarted a median of 3.0 (1.0–7.0) days after the procedure in 44 patients.
• Early recurrent AF with low-grade fevers (37.4 ± 0.5 °C) and an elevated C-reactive protein [2.4 (1.1–8.5) mg/dL] was reported in 30 (58.8%) patients.
• Cerebral infarctions were detected in 2 (3.9%) patients despite restarting anticoagulation therapy, even after successful management of tamponade.
• Death was reported in 1 patient, and the other completely recovered without any neurological deficit.
• It was noted that recurrent post-cardiac injury syndrome (PCIS) occurred on post-procedural Day 13 in another patient, requiring oral prednisone administration for 10 months.
• In addition, 34 (66.7%) patients were found to be arrhythmia free during a median follow-up of 23 (5.4–46.1) months.