title: Pericardial effusion following drain removal after percutaneous epicardial access for an electrophysiology procedure.
abstract: OBJECTIVE
  To determine the frequency and predictors of pericardial effusion following epicardial sheath removal.
  
  
  BACKGROUND
  Pericardial effusion can occur following cardiac surgical or interventional procedures including percutaneous epicardial access (EpiAcc), which is increasingly used as part of electrophysiology ablation procedures.
  
  
  METHODS
  A retrospective analysis of the Mayo Clinic comprehensive electronic medical record was performed from all patients who underwent planned EpiAcc as part of an electrophysiology ablation procedure between January 1, 2004 and June 30, 2013.
  
  
  RESULTS
  Of 144 patients (mean age 51.3 ± 15.5 years, 68% male) who underwent planned EpiAcc as part of an electrophysiology ablation (95.8% pericardial access success rate), seven (4.9%) developed a postoperative pericardial effusion requiring repeat EpiAcc. Inferior access was utilized in 74 (51.4%) patients. Patients with pericardial effusion tended to be younger (41.1 years vs 51.8 years, P = 0.08) and were more likely to have undergone inferior approach access (85.7% vs 49.6%, P = 0.06) than those who did not develop postoperative pericardial effusion. Seventy-one percent of patients with postoperative pericardial effusion versus 32.1% of patients without postoperative pericardial effusion had a preprocedure ejection fraction ≥55% (P = 0.03). There were no procedural-related deaths, and no difference in mortality between groups.
  
  
  CONCLUSIONS
  Postoperative pericardial effusion requiring repeat access/drainage was relatively infrequent, occurring in 4.9% of patients shortly after epicardial procedures. While the majority occur early and therefore require close observation, some patients may present in a delayed manner.
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota; Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Ammar M
authors.initials: AM
authors.lastname: Killu
authors.forename: Siu-Hin
authors.initials: SH
authors.lastname: Wan
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Munger
authors.forename: David O
authors.initials: DO
authors.lastname: Hodge
authors.forename: Siva
authors.initials: S
authors.lastname: Mulpuru
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Packer
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Asirvatham
authors.forename: Paul A
authors.initials: PA
authors.lastname: Friedman
mesh_terms: D004322:Drainage; D004452:Echocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006331:Heart Diseases / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: effusion; ejection fraction; epicardial; pericardial; tamponade