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

Abstract

BackgroundCardiac tamponade (CT) can be a complication following invasive cardiac procedures. We assessed CT following common cardiac electrophysiology (EP) procedures to facilitate risk prediction of associated morbidity and in‐hospital mortality.MethodsPatients who underwent various EP procedures in the cardiac catheterization lab (ablations and device implantations) were identified using the International Classification of Diseases, Ninth and Tenth Edition, Clinical Modification (ICD‐9‐CM and ICD‐10‐CM, respectively) from the Nationwide Inpatient Sample (NIS) database. Patient demographics, presence of comorbidities, CT‐related events, and in‐hospital death were also abstracted from the NIS database.ResultsThe frequency of CT‐related events in patients with EP intervention from 2010 to 2017 ranged from 3.4% to 7.0%. In‐hospital mortality related to CT‐related events was found to be 2.2%. Increasing age was the only predictor of higher mortality in atrial fibrillation (AF) ablation and cardiac resynchronization therapy (CRT) groups (OR [95% CI]: AF ablation = 11.15 [1.70–73.34], p = .01; CRT = 1.41 [1.05–1.90], p = .02).ConclusionsIn the real‐world setting, CT‐related events in EP procedures were found to be 3.4%–7.0% with in‐hospital mortality of 2.2%. Older patients undergoing AF ablation were found to have higher mortality.

Factors associated with procedure‐related cardiac tamponade

“…An intriguing observation made in their study is the comparatively higher incidence of cardiac tamponade after catheter ablation, approximately 5%, 1 as contrasted with a lower incidence, below 1%, reported in the Japanese context. 2 It would be insightful for the authors to conduct a comparative analysis between countries, delving into the incidence of procedure‐related complications, including cardiac tamponade.…”

“…Deshpande and colleagues conducted a rigorous investigation into the incidence of cardiac tamponade following invasive cardiac procedures, utilizing a nationwide inpatient sample database. 1 Their compelling findings demonstrated that the occurrence of cardiac tamponade during cardiac electrophysiology procedures ranged from 3.4% to 7.0%, with a corresponding in‐hospital mortality rate of 2.2% in real‐world clinical settings. However, several pertinent concerns have been raised regarding the scope of their study.…”

“…Notably, the study highlights that older patients undergoing atrial fibrillation ablation exhibited a higher mortality rate. 1 Should any modifiable factors be identified, intervening in such variables may offer a promising avenue to mitigate the incidence of complications, thereby enhancing patient safety and clinical outcomes.…”

Response to letter to editor, re‐predictors of morbidity and in‐hospital mortality following procedure‐related cardiac tamponade

“…Also, all these patients underwent pericardiocentesis, a few requiring other surgical interventions and transfusion as well, as has been mentioned in our supplementary file and our methods section. 3 We have divided these complications into two types of events—intervention‐related events (viz. hemopericardium, acute post‐hemorrhagic anemia, hemorrhage complicating a procedure, or hematoma) or severe events (viz.…”

“…To find out the modifiable predictors for the events (especially mortality), we carried out a multivariable logistic regression analysis including patient comorbidities and hospital bed size (wide methods section), which did not reveal any statistically significant factor. 3 …”