Removing pericardial drainage tube for acute cardiac tamponade associated with catheter ablation of atrial fibrillation can trigger hemoperitoneum from severe liver bleeding

Successful, urgent, single-stage endo-epicardial catheter ablation with a surgically subxiphoid pericardial window for a drug-resistant ventricular tachycardia storm in an extremely old hemodialysis patient with ischemic cardiomyopathy

“…Liver puncture is another potential complication associated with percutaneous epicardial access that can occur, like pericardiocentesis for cardiac tamponade. 10 We performed the endocardial procedure under full heparinization to prevent blood clots. As we switched to the epicardial approach, we kept the catheter in place within the left ventricle at all times, and also used full heparinization (activated clotting time >300) during the procedure, with an elevated risk of complications associated with percutaneous epicardial access.…”