Delayed tamponade triggering Dressler’s syndrome after pulmonary vein isolation

Abstract

Percutaneous catheter ablation is now a well-established, efficient and effective treatment strategy for recurrent, symptomatic atrial fibrillation (AF). Major complications though occur in up to 5.9% of procedures. New complications still continue to emerge. Delayed tamponade is only recently recognized as a major complication after ablation. We present a 68-year-old female patient who develops cardiac tamponade requiring pericardiocentesis 12 days after AF ablation. Subsequently, the tamponade triggers a Dressler syndrome with repetitive pleural effusions only adequately responsive to corticosteroids.

Two Cases of Delayed Cardiac Tamponade due to Pericarditis after Pulmonary Vein (PV) Isolation for Atrial Fibrillation

“…The onset of Dressler's syndrome following catheter ablation has been previously reported (4,8,9); corticosteroids were used for treatment in several cases (4,8). Fortunately, our patients exhibited good clinical courses, with only treatment with NSAIDs and pericardiocentesis.…”

“…Although the mechanisms underlying the development of DCT remain unclear, several causes can be speculated. For example, Goossens et al reported that potential mechanisms include sealed ablation-induced left atrial rupture or small pericardial hemorrhage due to the application of post-procedural anticoagulation therapy (4). According to Cappato's report (6) of 45 patients with DCT, hemorrhagic pericardial fluid was reported upon visual inspection in 36 patients, whereas serous effusion was the only finding in the remaining nine patients.…”

“…Cardiac tamponade may occur during or immediately after pulmonary vein (PV) isolation, at a rate of between 0.6% and 1.3% (2,3). Delayed cardiac tamponade (DCT) is a rare, although recently recognized, major complication (4,5). In a recent worldwide survey (6), the incidence of DCT was reported to be 0.2%, with a mortality rate of 5%.…”

A New Endobronchial Ultrasound (EBUS) Application for Benign and Malignant Pericardial Effusion (PE) Aspiration: Transbronchial Pericardial Effusion Aspiration (TPEA) with a Regular EBUS Transbronchial (TBNA) Needle under Apneic Nasal Jet-Catheter Ventilation

“…102,103 Delayed PE after endocardial ablation like in pulmonary vein isolation has occured. 104,105 Interestingly recent experimental publications on an 'easy' approach for pulmonary vein isolation in atrial fibrillation consider transapical puncture of the left ventricle for retrograde transmitral access to the pulmonary veins. 106 In regards to such a proposed and in our view 'aggressive' approach it is quite assumable that -as already mentioned 19 -with TPEA even perfused vascular or cardiac structures are easily entered in a very controllable manner.…”

Delayed cardiac tamponade 8 months after pulmonary vein isolation

“…On the other hand, cardiac tamponade occurring after PVI procedure called delayed cardiac tamponade (DCT) is not widely recognized. According to several reports [1,[5][6][7][8][9][10], DCT occurs between 0.2 and 55 days after PVI. However, we experienced a case in whom DCT occurred 8 months after PVI.…”