![]() It is exceedingly rare, with the most series reports after ablation of atrial fibrillation (AF). 3c).ĭCT due to catheter ablation has been described as hypotension or cardiogenic shock requiring pericardial drainage at least 1 h after the procedure. No signs of PE recurred during a 12-month follow-up (Fig. She was discharged after a 2-week hospitalization for investigating other probable causes, such as cancer, infection, and autoimmune disease, with negative results. On the third day of hospital admission, TTE showed no evidence of PE. The next day, her condition improved, becoming conscious. She was monitored in the Cardiac Care Unit overnight without signs of fluid re-accumulation. Following an emergent pericardiocentesis to drain a hemorrhagic effusion (200 mL), the patient’s hemodynamics improved significantly. TTE revealed a moderate PE (12 mm) with evidence of tamponade, prompting a diagnosis of delayed cardiac tamponade (DCT) (Fig. The patient’s recent history of cardiac ablation alerted us of the possibility of cardiac problems. All blood test parameters were normal, except for an extremely elevated D-dimer (2450 μmol/L). Brain CT scans excluded cerebral hemorrhage. Upon physical examination, her neck veins were distended, lungs were clear, and heart sounds were distant. She appeared pale with blood pressure 50/40 mmHg, heart rate 110 bpm, and oxygen saturation of 100% on oxygen (on 3 L oxygen per nasal cannula). Nineteen days later, the patient was sent to our hospital after experiencing sudden syncope. She was discharged symptom-free from the hospital 1 day after the procedure (blood pressure, 124/64 mmHg heart rate, 83 bpm), without anticoagulant or antiplatelet treatment. Pericardial effusion (PE) was not evident in the post-procedure transthoracic echocardiography (TTE). A total of 3000 U heparin was given during the procedure. PVCs were no longer observed for a period of 30 min during infusion of isoproterenol (4 μg/min). ![]() After termination of PVCs within 1 s, RF delivery continued for up to 90 s at a power setting of 30–40 W with a target temperature of 55 ☌ (Fig. Radiofrequency (RF) current was applied at this location. The earliest activation timing of PVCs was identified on the posterior-lateral wall of the RVOT with a local activation time of 25 ms (Fig. Namely, a roving standard ablation catheter (7 French, 4-mm tip) introduced from the right femoral vein was used for location of the earliest activation site. A single conventional catheter guided by fluoroscopy was selected for mapping and ablation. The electrocardiogram (ECG) morphology of the PVCs suggested a right ventricular outflow tract (RVOT) origin (Fig. This case report demonstrated, for the first time, that very late post-procedural cardiac tamponade might occur after catheter ablation of ventricular arrhythmias, even without antithrombotic treatment.Ī 66-year-old woman without structural heart disease, but with a significant PVC burden of 47% (49,939/105,871 beats), was referred to the Electrophysiology Laboratory for possible catheter ablation of the PVC focus following lack of symptomatic improvement with medical treatment. No signs of pericardial effusion recurred in a follow-up time of 12 months. The patient was discharged after a 2-week hospitalization for investigating other probable causes with negative results. Following an emergent pericardiocentesis to drain a 200 mL hemorrhagic effusion, the patient’s hemodynamics improved significantly. Transthoracic echocardiography revealed hemorrhagic cardiac tamponade, which was considered due to a delayed tiny perforation in the heart induced by the previous ablation. Upon arriving at our hospital, she was “confused and shock”. Nineteen days after ablation, the patient experienced sudden syncope. Case presentationĪ 66-year-old woman who underwent successful catheter ablation of right ventricular outflow tract origin premature ventricular complexes. Here, we present a very incredible case about delayed cardiac tamponade after ablation of premature ventricular complexes. It often happens during or shortly after the procedure and needs urgent treatment. Cardiac tamponade is a potentially fatal complication after catheter ablation of ventricular arrhythmias.
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