Delayed cardiac tamponade 8 months after pulmonary vein isolation

Abstract

We herein report the case of a 55 year-old male who underwent pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation. From 8 months after PVI, exertional dyspnea rapidly appeared. When he was referred to our hospital, massive pericardial effusion was observed by transthoracic echography. The pericardiocentesis revealed bloody pericardial effusion, and improved symptoms. Although aortic dissection, autoimmune disease, infection, metastatic pericardial tumor, primary pericardial tumor, and malignant neoplasm were considered as differential diagnosis, the cause of pericardial effusion failed to be found. From these findings, the cause of hemorrhagic pericardial effusion was considered delayed cardiac tamponade induced by PVI performed 8 months earlier. <Learning objective: Cardiac tamponade occurring after pulmonary vein isolation (PVI) procedure called delayed cardiac tamponade (DCT) is not widely recognized. However, mortality from DCT is far less than 5%, and we believe that it is a complication that requires due care. This report describes that DCT can occur even after 8 months of PVI.>

Delayed cardiac tamponade in catheter ablation for paroxysmal atrial fibrillation induced by a subacute hemorrhage

“… 3 , 4 , 5 However, clinicians are still uncertain regarding whether the mechanism could be extrapolated to cases of DCT that developed more than 3 months after the procedure, because ablation-induced scar formation is usually completed within 3 months. 6 Yamanaka and colleagues 2 described a 55-year-old man who developed DCT 8 months after PVI without anticoagulant administration. However, when the patient in this case developed DCT is unknown, because assessments by imaging modalities, such as chest radiograph and echocardiography, were not performed until the onset of symptoms.…”

“…However, occurrence of DCT more than 3 months after the procedure is particularly rare. 2 Information regarding the time and mechanism of development of this complication remains unknown. Here, we present a patient who developed DCT as a complication 3 months after catheter ablation with subacute hemorrhage as the possible contributing factor.…”

Delayed pericardial tamponade following central venous recanalization

“…3 Although there are well-described complications during endovascular treatments of SVCO, delayed pericardial tamponade post sharp recanalization had been rarely reported. 4,5 Thus, this study reports a rare, delayed case of iatrogenic cardiac tamponade (ICT) secondary to sharp recanalization for tunneled dialysis catheter-induced central venous complete occlusion at the junction of SVC and the right atrium.…”