Management of cardiac tamponade in catheter ablation of atrial fibrillation: single-centre 15 year experience on 5222 procedures.

Aims: Cardiac tamponade during atrial fibrillation (AF) ablation is infrequent but potentially fatal. This study aimed to retrospectively investigate the incidence, management, and outcomes of tamponade in large patient series.

Methods and results: The study analysed 5222 AF ablation procedures in 3483 patients between 2002 and 2016 under a heparin-bridge anticoagulation protocol. Cardiac tamponade occurred in 51 procedures/patients, and the 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. No clinical factors were associated with the occurrence, but it was lower during cryoballoon than radiofrequency ablation (P = 0.025). Pericardiocentesis was required in 44 (86.3%) patients, and the haemodynamic state stabilized after a total of 377 (260-530) mL of pericardial blood drainage except for in 2 (3.9%) patients requiring subsequent emergent surgical repairs. The pericardial drain was successfully removed after a median of 1.0 (1.0-2.0) days. In 44 patients, anticoagulation therapy was restarted a median of 3.0 (1.0-7.0) days after the procedure. Thirty (58.8%) patients experienced 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]. After successful management of tamponade, 2 (3.9%) patients exhibited cerebral infarctions despite restarting anticoagulation therapy. One patient died, and the other completely recovered without any neurological deficit. Recurrent post-cardiac injury syndrome (PCIS) occurred on post-procedural Day 13 in another patient, requiring oral prednisone administration for 10 months. During a median follow-up of 23 (5.4-46.1) months, 34 (66.7%) patients were arrhythmia free.

Conclusions: Despite an infrequent incidence, surgical backup is essential for performing AF ablation. Even after successful management of tamponade, care should be taken for subsequent complications.