Management of acute cardiac tamponade by direct autologous blood transfusion in interventional electrophysiology

Abstract

Aims: Acute cardiac tamponade (ACT) is the most common life-threatening complication of interventional electrophysiology. Urgent drainage by percutaneous pericardiocentesis and anticoagulation reversal are required. Immediate direct transfusion of the blood volume aspirated from the pericardial space to the patient has been rarely described. This study was designed to assess the efficacy and safety of immediate direct autologous blood transfusion (AutoBT).Methods: A retrospective case series of direct AutoBT performed for ACT was collected.Urgent drainage by percutaneous pericardiocentesis and immediate direct AutoBT were performed to achieve hemodynamic stabilization without a cell-saver system.Results: Twenty-two electrophysiology centers were contacted to participate in the case series. Fourteen centers reported not to use direct AutoBT. Three centers reported using direct AutoBT with the cell-saver system. Fourteen cases of immediate direct AutoBT without cell-saver system were included from the five remaining centers.Electrophysiological procedures were performed for ventricular tachycardia (n = 5), atrial fibrillation (n = 5), atrial tachycardia (n = 2), left accessory pathway (n = 1), and premature ventricular contraction (n = 1) with transseptal (n = 9), retroaortic (n = 4), and/or epicardial access (n = 4). Pericardial drainage was performed by percutaneous pericardiocentesis for 13 patients and via the transseptal sheath for one patient. Surgical hemostasis was required for seven patients. The mean volume of autologous blood directly transfused was 1207 ± 963 mL. Direct AutoBT permitted to resume the procedure in four patients. No major complication related to the use of AutoBT occurred. Conclusion: Direct AutoBT without a cell-saver system is a feasible, safe, and useful technique for salvage therapy in ACT in interventional electrophysiology. K E Y W O R D S autotransfusion, catheter ablation, interventional electrophysiology, tamponade Josselin Duchateau

Direct autotransfusion in the management of acute pericardial tamponade during catheter ablation for atrial fibrillation: An imperfect but practical method

“…However, DAT has not been routinely adopted by most interventional electrophysiologists due to its potential risks of thrombotic and infective events. Recently, two studies (10,11) preliminary investigated the feasibility of DAT in APT during the perioperative period of EP procedures and revealed that DAT reduced the need for allotransfusion and surgical repair without increasing major complications. However, among different EP procedures, only a few (<10) AF patients were enrolled in either study, therefore, their conclusions cannot be completely applicable for AF-CA and need to be further explored.…”

“…Direct autotransfusion (DAT), a method of reinjecting aspirated pericardial blood directly back into the body via venous access without a cell-salvage system, may be easy to operate and can quickly stabilize hemodynamic status and buy time for anticoagulation reversal or cardiac surgical repair. Previous studies had reported cases of applying DAT to deal with APT during the perioperative period of AF-CA (9)(10)(11)(12)(13). However, despite the many potential advantages, DAT has not been conventionally adopted yet, due to the lack of consensus on security.…”

Minimally Interrupted Non-Vitamin K Antagonist Oral Anticoagulants vs. Bridging Therapy and Uninterrupted Vitamin K Antagonists During Atrial Fibrillation Ablation: A Retrospective Single-Center Study

“…Protamine was administered in 14 patients for periprocedural heparin reversal. Direct autologous blood transfusion (AutoBT) was performed routinely as salvage therapy to allow maintenance the hemodynamic status (13). Despite pericardiocentesis, anticoagulation reversal, and AutoBT, an emergent open-chest surgery was required in 11 (52.4%) patients due to persistent reaccumulation of blood in the pericardial space.…”

Predictors of morbidity and in‐hospital mortality following procedure‐related cardiac tamponade

“…Percutaneous cardiac interventions are increasingly utilized with varying procedure complexity and ongoing technological innovations 1 . Specific steps during procedures (e.g., transseptal puncture) increase the risk of developing pericardial effusion, which may then lead to cardiac tamponade (CT) 2 . Coronary interventional (CI) procedures and complications like guidewire‐related coronary perforation, intracoronary balloon rupture, and atherectomy device‐related rupture can lead to pericardial effusion and CT, requiring acute, life‐saving intervention 3,4 .…”

“… 1 Specific steps during procedures (e.g., transseptal puncture) increase the risk of developing pericardial effusion, which may then lead to cardiac tamponade (CT). 2 Coronary interventional (CI) procedures and complications like guidewire‐related coronary perforation, intracoronary balloon rupture, and atherectomy device‐related rupture can lead to pericardial effusion and CT, requiring acute, life‐saving intervention. 3 , 4 Electrophysiology procedures (EP), such as device implantations (including left atrial appendage occlusion [LAAO]) and ablation procedures may also be complicated by pericardial effusion and CT. 5 Most EP procedures are performed using venous access (low pressure), except ablations done in the left atrium or left ventricle, whereas coronary interventional procedures generally involve the arterial (high pressure) side of the circulation.…”