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

Abstract

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 5 13, 72%), premature ventricular contraction (n 5 2, 11%), ventricular tachycardia (n 5 1, 6%), atrial flutter (n 5 1, 6%), and orthodromic reciprocating tachycardia (n 5 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.

Diagnosis and Management of Left Ventricular Perforation During Mapping of Ventricular Tachycardia

“…The incidence of pericardial effusion and cardiac tamponade after VT or premature ventricular contractions (PVC) ablation is 1–2% [ 2 , 3 ]. It is generally perceived that the perforation risk in atrial ablation is higher than in ventricular procedures, due to differences in wall thickness, although many studies reported similar risks in both types of procedures [ 3 , 9 ]. Moreover, the risk of RV perforation is significantly higher than that of LV perforation [ 9 ].…”

“…Its efficacy in reduction of appropriate implantable cardioverter defibrillator (ICD) shock incidence has been proven in randomized control trials, but the benefit on mortality has only been demonstrated in patients with VT storm [ 1 ]. Catheter-based ablation may be associated with complications including cardiac perforation in 1–2% of patients [ 2 , 3 ]. Most of the perforations are caused by a steam pop phenomenon, which refers to barotrauma due to excessive heating leading to production of gas during catheter ablation, or by complications related to transseptal punctures.…”