Assessing the perforation site of cardiac tamponade during radiofrequency catheter ablation using gas analysis of pericardial effusion

• Main Authors: Yumi Katsume, MD, Akiko Ueda, MD, Takato Mohri, MD, Mika Tashiro, MD, Yuichi Momose, MD, Noriko Nonoguchi, MD, Kyoko Hoshida, MD, Yosuke Miwa, MD, Ikuko Togashi, MD, Toshiaki Sato, MD, Kyoko Soejima, MD
• Format: Article
• Language: English
• Published: Elsevier 2020-10-01
• Series: Heart Rhythm O2
• Subjects: Atrial fibrillation; Catheter ablation; Gas analysis; Pericardial effusion; Pericardiocentesis
• Online Access: http://www.sciencedirect.com/science/article/pii/S2666501820300787
• ISSN: 2666-5018

Background: The incidence of pericardial effusion (PE) during radiofrequency catheter ablation (CA) for atrial fibrillation is approximately 1%. PE is a major complication during CA, but there has been limited literature about the perforation site responsible. Objective: This study aimed to retrospectively investigate the characteristics of the procedure and the patients in whom PE developed during CA. Methods: Of 1363 consecutive patients who underwent catheter ablation from January 2015 to June 2019 in Kyorin University Hospital, we reviewed patients who developed PE during CA. Results: PE during CA occurred in 18 (1.32%) patients (median age, 71 [interquartile range (IQR) 65–77] years, 7 women). The median body mass index was 24 (IQR 20–27). Target arrhythmias for CA of patients with PE include atrial fibrillation (AF) (n = 13, 72%), premature ventricular contraction (n = 2, 11%), ventricular tachycardia (n = 1, 6%), atrial flutter (n = 1, 6%), and orthodromic reciprocating tachycardia (n = 1, 6%). Seventeen patients required pericardiocentesis, resulting in 300 (IQR 192.5–475) mL of drainage. Two patients required emergency surgical repair, and 1 died from aortic dissection. Based on the gas analysis, the drained blood was of venous origin in 47% of the total events and 54% of AF ablation. Conclusion: PE caused by a diagnostic catheter in the right heart is not uncommon, even in AF ablation.