SpringerLink
Log in

Surgical intervention for cardiac tamponade during atrial fibrillation ablation: who and when?—a single-center experience

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Introduction

The critical decision between conservative therapy and surgical intervention to manage cardiac tamponade (CT) during atrial fibrillation (AF) ablation remains empirical. The aim of the study was to summarize the experience in management of CT during AF ablation to derive a proper management pathway.

Methods

All patients with CT who underwent catheter ablation for AF in our center from 2013 to 2019 were included.

Results

In total of 4887 patients, 32 (0.65%) patients occurred CT and received pericardiocentesis and immediate reversal of anticoagulation. All the CT patients were classified into three groups: rapid and uncontrollable bleeding who needed urgent surgical intervention (4/32), continuous bleeding (14/32), once pericardiocentesis, and no further bleeding (14/32). In the continuous bleeding group, the drainage volume in the first hour after pericardiocentesis was statistically related to surgical repair (p = 0.04) with a cutoff point of 970 ml (AUC 0.84, sensitivity 71.4%, specificity 100%, p = 0.04). During surgical repair, most of perforation sites were detected at superior anterior wall of left atrium close to right or left superior pulmonary vein antrum. No patient died of CT in our cohort.

Conclusions

Only a small proportion of patients with CT required surgical intervention during AF ablation. When pericardiocentesis was performed, if a drainage volume was more than 1000 ml in the first hour or bleeding was accelerated after an hour of observation, emergency surgical repair should be recommended.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig 6

Similar content being viewed by others

References

  1. Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, et al. Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation. 2005;111:1100–5.

    Article  PubMed  Google Scholar 

  2. Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, et al. Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ Arrhythm Electrophysiol. 2010;3:32–8.

    Article  PubMed  Google Scholar 

  3. Chen H, Fink T, Zhan X, Chen M, Eckardt L, Long D, et al. Inadvertent transseptal puncture into the aortic root: the narrow edge between luck and catastrophe in interventional cardiology. Europace. 2019;21:1106–15.

    Article  PubMed  Google Scholar 

  4. Claridge S, Kapetanakis S, Gill J, Rinaldi CA, Wright M. A rare complication from transseptal puncture-persistent aorto-right atrial shunt and puncture of noncoronary cusp of aortic valve. Heart Rhythm. 2012;9:2089–90.

    Article  PubMed  Google Scholar 

  5. Hsu LF, Jais P, Hocini M, Sanders P, Scavee C, Sacher F, et al. Incidence and prevention of cardiac tamponade complicating ablation for atrial fibrillation. Pacing Clin Electrophysiol. 2005;28(Suppl 1):S106–9.

    Article  PubMed  Google Scholar 

  6. Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary. Europace. 2018;20:157–208.

    Article  PubMed  Google Scholar 

  7. Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, et al. Prevalence and causes of fatal outcome in catheter ablation of atrial fibrillation. J Am Coll Cardiol. 2009;53:1798–803.

    Article  PubMed  Google Scholar 

  8. Liu N, Zhao Q, Li L, Zhang M, Huang J, Wei S, et al. Association between the use of contact force-sensing catheters and cardiac tamponade in atrial fibrillation ablation. J Interv Card Electrophysiol. 2019;55:137–43.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Bunch TJ, Asirvatham SJ, Friedman PA, Monahan KH, Munger TM, Rea RF, et al. Outcomes after cardiac perforation during radiofrequency ablation of the atrium. J Cardiovasc Electrophysiol. 2005;16:1172–9.

    Article  PubMed  Google Scholar 

  10. Mujovic N, Marinkovic M, Markovic N, Kocijancic A, Kovacevic V, Simic D, et al. Management and outcome of periprocedural cardiac perforation and tamponade with radiofrequency catheter ablation of cardiac arrhythmias: a single medium-volume center experience. Adv Ther. 2016;33:1782–96.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Hamaya R, Miyazaki S, Taniguchi H, Kusa S, Nakamura H, Hachiya H, et al. Management of cardiac tamponade in catheter ablation of atrial fibrillation: single-centre 15 year experience on 5222 procedures. Europace. 2018;20:1776–82.

    Article  PubMed  Google Scholar 

  12. Zhao Q, Li L, Liu N, Zhang M, Wu K, Ruan Y, et al. Early versus delayed removal of the pericardial drain in patients with cardiac tamponade complicating radiofrequency ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2020;31:597–603.

    Article  PubMed  Google Scholar 

  13. Yang B, Jiang C, Lin Y, Yang G, Chu H, Cai H, et al. STABLE-SR (Electrophysiological substrate ablation in the left atrium during sinus rhythm) for the treatment of nonparoxysmal atrial fibrillation: a prospective, multicenter randomized clinical trial. Circ Arrhythm Electrophysiol. 2017;10:e005405.

    PubMed  Google Scholar 

  14. Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, et al. Delayed cardiac tamponade after radiofrequency catheter ablation of atrial fibrillation: a worldwide report. J Am Coll Cardiol. 2011;58:2696–7.

    Article  PubMed  Google Scholar 

  15. Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, la Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, van Gelder IC, van Putte BP, Watkins CL, ESC Scientific Document Group, Kirchhof P, Kühne M, Aboyans V, Ahlsson A, Balsam P, Bauersachs J, Benussi S, Brandes A, Braunschweig F, Camm AJ, Capodanno D, Casadei B, Conen D, Crijns HJGM, Delgado V, Dobrev D, Drexel H, Eckardt L, Fitzsimons D, Folliguet T, Gale CP, Gorenek B, Haeusler KG, Heidbuchel H, Iung B, Katus HA, Kotecha D, Landmesser U, Leclercq C, Lewis BS, Mascherbauer J, Merino JL, Merkely B, Mont L, Mueller C, Nagy KV, Oldgren J, Pavlović N, Pedretti RFE, Petersen SE, Piccini JP, Popescu BA, Pürerfellner H, Richter DJ, Roffi M, Rubboli A, Scherr D, Schnabel RB, Simpson IA, Shlyakhto E, Sinner MF, Steffel J, Sousa-Uva M, Suwalski P, Svetlosak M, Touyz RM, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, la Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Neil Thomas G, Valgimigli M, van Gelder IC, Watkins CL. ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2020. https://doi.org/10.1093/eurheartj/ehaa612.

    Article  Google Scholar 

  16. Yoav M, Michael R, Hakan O, et al. Effects of sex on the incidence of cardiac tamponade after catheter ablation of atrial fibrillation: results from a worldwide survey in 34 943 atrial fibrillation ablation procedures. Circ Arrhythm Electrophysiol. 2014;7:274–80.

    Article  Google Scholar 

  17. Natale A, Reddy VY, Monir G, Wilber DJ, Lindsay BD, McElderry HT, et al. Paroxysmal AF catheter ablation with a contact force sensing catheter: results of the prospective, multicenter SMART-AF trial. J Am Coll Cardiol. 2014;64:647–56.

    Article  PubMed  Google Scholar 

  18. Reddy Vivek Y, Dukkipati Srinivas R, Petr N, et al. Randomized, controlled trial of the safety and effectiveness of a contact force-sensing irrigated catheter for ablation of paroxysmal atrial fibrillation: results of the TactiCath Contact Force Ablation Catheter Study for Atrial Fibrillation (TOCCASTAR) Study. Circulation. 2015;132:907–15.

    Article  CAS  PubMed  Google Scholar 

  19. Yetter E, Brazg J, Del VD, Mulvey L, Dickman E. Delayed cardiac tamponade: A rare but life-threatening complication of catheter ablation. Am J Emerg Med. 2017;35:801–3.

    Article  Google Scholar 

  20. Jais P, Hocini M, O’Neill MD, Klein GJ, Knecht S, Sheiiro M, et al. How to perform linear lesions. Heart Rhythm. 2007;4:803–9.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Yunfan Tian from Department of Cardiology, the First Affiliated Hospital of Nan**g Medical University, China, for statistical analysis.

Author information

Author notes

  1. Nan Wu and Fengming Wu contributed equally to this work.

Authors and Affiliations

  1. Division of Cardiology, The First Affiliated Hospital of Nan**g Medical University, Nan**g, 210029, China

    Nan Wu, Fengming Wu, Gang Yang, Weizhu Ju, Mingfang Li, Hongwu Chen, Kai Gu, Zidun Wang, Hailei Liu, Yanjuan Zhang & Minglong Chen

Authors
  1. Nan Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fengming Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gang Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Weizhu Ju
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mingfang Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hongwu Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kai Gu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Zidun Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hailei Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yanjuan Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Minglong Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Minglong Chen.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wu, N., Wu, F., Yang, G. et al. Surgical intervention for cardiac tamponade during atrial fibrillation ablation: who and when?—a single-center experience. J Interv Card Electrophysiol 62, 373–380 (2021). https://doi.org/10.1007/s10840-020-00907-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-020-00907-7

Keywords

Search

Navigation