Management and clinical outcomes of acute cardiac tamponade complicating electrophysiologic procedures: a single-center case series.
BACKGROUND
Cardiac perforation with tamponade is an infrequent occurrence during an electrophysiologic procedure. The customary approach to management includes volume resuscitation followed by pericardiocentesis. Such a procedure, however, is not without its own risk, especially when performed emergently. We hypothesized that some patients experiencing this type of complication can be managed successfully in a conservative fashion, without the need for an additional invasive procedure.


METHODS
We retrospectively analyzed the clinical outcomes and echocardiographic features of 33 consecutive patients who experienced this complication during cardiac electrophysiology (EP) procedures performed at our institution from 1988 to 2007. Nineteen patients (58%) were managed conservatively with intravenous fluids and vasopressors (Group A). Fourteen patients (42%) were managed invasively with pericardiocentesis (Group B).


RESULTS
The mean systolic blood pressure at diagnosis did not differ between the two groups (64 vs 71 mmHg, P = 0.134). The mean lengths of hospitalization (4.7 vs 4.9 days, P = 0.75) and survival to hospital discharge (100% in both groups) were also similar. A large pericardial effusion (>or=2 cm) was seen predominantly among Group B patients. There was a statistically significant temporal trend toward managing this type of complication invasively (P = 0.038).


CONCLUSIONS
Among patients who experience cardiac perforation as an acute complication of EP procedure, there appears to be a role for conservative management in a subset of patients who do not have echocardiographic evidence of a large effusion and who respond well to initial stabilizing measures consisting of fluids and vasopressors.
Section of Cardiac Electrophysiology, University of Florida/Shands, Jacksonville, Florida, USA. robert.kim@jax.ufl.edu
Robert J
RJ
Kim
Samer
S
Siouffi
Todd A
TA
Silberstein
Salvatore P
SP
Costa
Jeremiah R
JR
Brown
Mark L
ML
Greenberg
D000208:Acute Disease; D000368:Aged; D001794:Blood Pressure; D002305:Cardiac Tamponade / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D015150:Echocardiography, Doppler; D022062:Electrophysiologic Techniques, Cardiac / Q000009:adverse effects*; D005260:Female; D006335:Heart Injuries / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007049:Iatrogenic Disease; D007262:Infusions, Intravenous; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D020519:Pericardiocentesis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D014662:Vasoconstrictor Agents