title: Delayed cardiac tamponade: A rare but life-threatening complication of catheter ablation.
abstract: Delayed cardiac tamponade (DCT) is a rare and life-threatening complication of catheter ablation performed as a treatment of atrial fibrillation, with few cases described in the medical literature. We present the case of a 57year-old man presenting with DCT 61days following a catheter ablation procedure. To the best of our knowledge, this is the most delayed case of cardiac tamponade (CT) following catheter ablation described in the literature. We also discuss the importance of point of care ultrasound (POCUS) in the diagnosis and treatment of CT. Emergency physicians must maintain a high index of suspicion in making the diagnosis of CT as patients may present with vague symptoms such as neck or back pain, shortness of breath, fatigue, dizziness, or altered mental status, often without chest pain. Common risk factors for CT include cancer, renal failure, pericarditis, cardiac surgery, myocardial rupture, trauma, and retrograde aortic dissection. In addition, although rare, both catheter ablation and use of anticoagulation carry risks of developing CT. A worldwide survey of medical centers performing catheter ablation found CT as a complication in less than 2% of cases [1]. Some proposed mechanisms of DCT include small pericardial hemorrhages following post-procedural anticoagulation or rupture of the sealed ablation-induced left atrial wall [2]. Clinical examination and electrocardiography may be helpful. However, the criterion standard for diagnosing CT is echocardiography [3].
authors.affiliation: Maimonides Medical Center, 4802 Tenth Ave., Brooklyn, NY 11217, United States.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Yetter
authors.affiliation: Maimonides Medical Center, 4802 Tenth Ave., Brooklyn, NY 11217, United States. Electronic address: jbrazg@maimonidesmed.org.
authors.forename: Jared
authors.initials: J
authors.lastname: Brazg
authors.affiliation: Maimonides Medical Center, 4802 Tenth Ave., Brooklyn, NY 11217, United States.
authors.forename: Diane
authors.initials: D
authors.lastname: Del Valle
authors.affiliation: Maimonides Medical Center, 4802 Tenth Ave., Brooklyn, NY 11217, United States.
authors.forename: Laura
authors.initials: L
authors.lastname: Mulvey
authors.affiliation: Maimonides Medical Center, 4802 Tenth Ave., Brooklyn, NY 11217, United States.
authors.forename: Eitan
authors.initials: E
authors.lastname: Dickman
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000628:therapy*; D002305:Cardiac Tamponade / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D017115:Catheter Ablation / Q000009:adverse effects*; D004635:Emergency Medicine; D006801:Humans; D008297:Male; D008875:Middle Aged; D020519:Pericardiocentesis / Q000379:methods*; D000069552:Rivaroxaban / Q000009:adverse effects / Q000627:therapeutic use*; D013575:Syncope / Q000209:etiology*; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000925:Anticoagulants; D000069552:Rivaroxaban
keywords: Cardiac tamponade; Cather ablation; Echocardiography; New oral anticoagulants; Pericardiocentesis