Background: Cardiac tamponade (CT) may occur intraprocedural or with delay after ablation procedures. Understanding the timepoint of occurrence of CT is crucial for rapid mangement.
Objective: To analyze the timepoint of occurence of CT after interventional electrophysiological procedures.
Methods: An observational study was performed on 34.982 consecutive patients undergoing ablation procedures at a high-volume electrophysiology center. Patients were included if procedure related CT occurred.The timepoint of CT was defined as the time at which patients underwent pericardiocentesis. CT was classified as intraprocedural or delayed CT.
Results: 226 patients (0.6%) with CT were identified. In 127 cases (56.2%) CT occured intraprocedural and in 99 cases (43.8%) postprocedural as delayed CT. In patients with delayed CT different timepoints of occurence were observed: In 76 cases (76.8%) CT occured when the patient was still in the electrophysiological laboratory after sheath removal, in 30 cases (30.3%) during stay in the wake-up area, in 34 cases (34.8%) during stationary stay and in 5 cases (5.1%) after discharge. Thirteen CTs (13.1% of delayed CTs, 0.04% of all patients undergoing EP procedures) occurred later than 24 hours postprocedural. The latest timepoint of CT was 220 days postprocedural. In 68 patients (68.7%) with postprocedural CT no signs of pericardial effusion were found in TTE after ablation. Blood gas analysis from pericardiocentesis in patients with delayed CT was available in 89 cases (89.9%): in 85 cases (95.5%) blood showed venous oxygenation indicating bleeding from the right atrium or coronary sinus while only in 4 patients (4.5%) blood showed arterial oxygenation indicating a bleeding site in left-sided heart. All patients with delayed CT survived after treatment. Patients with arterial bleeding could be treated effectively by pericardiocentesis only, while 2 patients (2.4%) with venous delayed CT needed surgical repair.
Conclusion: CT after electrophysiological procedures may occur intraprocedural or with delay. Delayed CT often results from venous bleeding and may require surgical repair. Repeat postprocedural TE controls are necessary for detection of delayed CT.