title: Management and Outcome of Periprocedural Cardiac Perforation and Tamponade with Radiofrequency Catheter Ablation of Cardiac Arrhythmias: A Single Medium-Volume Center Experience.
abstract: Cardiac tamponade (CT) is a life-threatening complication of radiofrequency ablation (RFA). The course and outcome of CT in low-to-medium volume electrophysiology centers are underreported.
  
  
  
  We analyzed the incidence, management and outcomes of CT in 1500 consecutive RFAs performed in our center during 2011-2016.
  
  
  
  Of 1500 RFAs performed in 1352 patients (age 55 years, interquartile range: 41-63), 569 were left-sided procedures (n = 406 with transseptal access). Conventional RFA or irrigated RFA was performed in 40.9% and 59.1% of procedures, respectively. Ablation was performed mostly for atrioventricular nodal reentrant tachycardia (25.4%), atrial fibrillation (AF; 18.5%), atrial flutter (18.4%), accessory pathway (16.5%) or idiopathic ventricular arrhythmia (VA; 12.3%), and rarely for structural VA (2.1%). CT occurred in 12 procedures (0.8%): 10 AF ablations, 1 idiopathic VA and 1 typical atrial flutter ablation. Factors significantly associated with CT were older age, pre-procedural oral anticoagulation, left-sided procedures, transseptal access, AF ablation, irrigated RFA and longer fluoroscopy time (on univariate analysis), and AF ablation (on multivariable analysis). The perforation site was located in the left atrium (n = 7), right atrium (n = 3), or in the left ventricle or coronary sinus (n = 1 each). Upon pericardiocentesis, two patients underwent urgent cardiac surgery because of continued bleeding. There was no fatal outcome. During the follow-up of 19 ± 14 months, eight patients were arrhythmia free.
  
  
  
  Incidence of RFA-related CT in our medium-volume center was low and significantly associated with AF ablation. The outcome of CT was mostly favorable after pericardiocentesis, but readily accessible cardiothoracic surgery back-up should be mandatory in RFA centers.
authors.affiliation: Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia. nmujovic@gmail.com.|School of Medicine, University of Belgrade, Belgrade, Serbia. nmujovic@gmail.com.
authors.forename: Nebojša
authors.initials: N
authors.lastname: Mujović
authors.affiliation: Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Milan
authors.initials: M
authors.lastname: Marinković
authors.affiliation: Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Nebojša
authors.initials: N
authors.lastname: Marković
authors.affiliation: Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Kocijančić
authors.affiliation: Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Vladan
authors.initials: V
authors.lastname: Kovačević
authors.affiliation: Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia.|School of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Dragan
authors.initials: D
authors.lastname: Simić
authors.affiliation: Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia.|School of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Arsen
authors.initials: A
authors.lastname: Ristić
authors.affiliation: Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia.|School of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Goran
authors.initials: G
authors.lastname: Stanković
authors.affiliation: Center for Anesthesia, Clinical Center of Serbia, Belgrade, Serbia.|Faculty of Stomatology, University of Belgrade, Belgrade, Serbia.
authors.forename: Biljana
authors.initials: B
authors.lastname: Miličić
authors.affiliation: School of Medicine, University of Belgrade, Belgrade, Serbia.|Clinic for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Svetozar
authors.initials: S
authors.lastname: Putnik
authors.affiliation: Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia.|School of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Bosiljka
authors.initials: B
authors.lastname: Vujisić-Tešić
authors.affiliation: Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia. tanjapotpara@gmail.com.|School of Medicine, University of Belgrade, Belgrade, Serbia. tanjapotpara@gmail.com.
authors.forename: Tatjana S
authors.initials: TS
authors.lastname: Potpara
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000601:surgery; D002305:Cardiac Tamponade / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D020519:Pericardiocentesis / Q000379:methods*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D055771:Serbia; D016896:Treatment Outcome
keywords: Atrial fibrillation; Cardiac perforation; Cardiac tamponade; Cardiology; Catheter ablation; Outcomes; Procedure-related complications