title: Management and outcomes of cardiac tamponade during atrial fibrillation ablation in the presence of therapeutic anticoagulation with warfarin.
abstract: BACKGROUND
  Cardiac tamponade (CT) is a possible complication of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF). Although the incidence of CT is not higher when RFCA is performed with a therapeutic international normalized ratio (INR), outcomes of CT are unclear.
  
  
  OBJECTIVE
  We compared outcomes among patients with and without a therapeutic INR who developed CT as a complication of RFCA of AF.
  
  
  METHODS
  The subjects of this retrospective study were 40 consecutive patients who developed CT during RFCA of AF at 3 centers. We divided the patients into 2 groups: RFCA performed with INR < 2 (group 1) and INR ≥ 2 (group 2). There were 23 patients in group 1 and 17 patients in group 2.
  
  
  RESULTS
  Baseline clinical and procedure characteristics were not different between the 2 groups. Heparin was reversed by protamine in 83% and 94% of patients (P = .37), and warfarin was reversed by fresh frozen plasma or factor VIIa in 17% and 35% of patients (P = .27) in groups 1 and 2, respectively. All patients were successfully treated by percutaneous drainage, and none required surgical intervention. There were no significant differences in the amount of initial pericardial drainage (523 ± 349 ml vs. 409 ± 157 ml, P = .22) or the duration of drainage (P = .14) between the 2 groups. All patients survived to hospital discharge. Median length of hospital stay was 2 days longer in group 1 (P <.01).
  
  
  CONCLUSIONS
  Cardiac tamponade is not more severe or difficult to manage in the presence of therapeutic anticoagulation with warfarin in patients undergoing RFCA of AF.
authors.affiliation: University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Latchamsetty
authors.forename: Sandeep
authors.initials: S
authors.lastname: Gautam
authors.forename: Deepak
authors.initials: D
authors.lastname: Bhakta
authors.forename: Aman
authors.initials: A
authors.lastname: Chugh
authors.forename: Roy M
authors.initials: RM
authors.lastname: John
authors.forename: Laurence M
authors.initials: LM
authors.lastname: Epstein
authors.forename: John M
authors.initials: JM
authors.lastname: Miller
authors.forename: Gregory F
authors.initials: GF
authors.lastname: Michaud
authors.forename: Hakan
authors.initials: H
authors.lastname: Oral
authors.forename: Fred
authors.initials: F
authors.lastname: Morady
authors.forename: Krit
authors.initials: K
authors.lastname: Jongnarangsin
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000628:therapy*; D002305:Cardiac Tamponade / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D020519:Pericardiocentesis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014859:Warfarin / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin