Catheter Ablation -> SVT/AVNRT/WPW/AT: -> Quality Measures & Complications D-PO05 - Poster Session V (ID 39) Poster

D-PO05-175 - Management And Outcome Of Periprocedural Cardiac Tamponade During Catheter Ablation For Atrial Fibrillation Under Uninterrupted Direct Oral Anticoagulant Versus Vitamin K Antagonist Administration: A Multicenter Study (ID 1295)


Background: Uninterrupted direct oral anticoagulant (DOAC) use during catheter ablation for atrial fibrillation (AF) reduces the risk of thromboembolic events but causes the life-threatening bleeding risk of cardiac tamponade.
Objective: This multi-center study aimed to evaluate cardiac tamponade management and outcomes in catheter ablation for AF under uninterrupted DOAC versus warfarin administration.
Methods: Of 3,149 catheter ablation procedures for AF with uninterrupted oral anticoagulant use in 2,406 patients in 3 institutions, 24 procedures/patients (0.8%/1.0%) developed cardiac tamponade requiring pericardiocentesis and surgical intervention. DOAC and warfarin were administered in 13 (0.7%) of 1,896 procedures and 11 (0.9%) of 1,253 procedures, respectively. We compared the outcomes between the two groups.
Results: Total blood and fluid volumes drained after the pericardiocentesis were 300 (190-715) vs. 300 (200-380) mL (p = 0.697), and 540 (245-860) vs. 330 (210-380) mL (p = 0.414) in the DOAC and warfarin groups, respectively. Approximately two-thirds of patients (9 in the DOAC and 7 in the warfarin groups) recovered with only pericardiocentesis and protamine infusion (plus vitamin K in the warfarin group) without additional blood transfusion or reversal agents in both groups. Two patients in the DOAC group underwent surgical intervention but recovered uneventfully. By contrast, none of the patients who received warfarin required surgical intervention. The drain catheter was removed at 41.0 (26.5-58.3) and 42.0 (21.0-63.0) hours after insertion in the DOAC and warfarin groups, respectively (p = 0.999). The DOAC and warfarin were successfully resumed 2.0 (2.0-5.0) and 4.0 (2.0-5.5) days after tamponade in all the patients, without increase in effusion (p = 0.102).
Conclusion: Management and outcomes of cardiac tamponade under uninterrupted DOAC administration were feasible compared to warfarin administration. Early intensive treatment resulted in hemostasis in most patients receiving DOAC. However, surgical intervention was required in some cases that were refractory to the initial treatment.