![]() The patient’s recent history of cardiac ablation alerted us of the possibility of cardiac problems. All blood test parameters were normal, except for an extremely elevated D-dimer (2450 μmol/L). Brain CT scans excluded cerebral hemorrhage. Upon physical examination, her neck veins were distended, lungs were clear, and heart sounds were distant. She appeared pale with blood pressure 50/40 mmHg, heart rate 110 bpm, and oxygen saturation of 100% on oxygen (on 3 L oxygen per nasal cannula). Nineteen days later, the patient was sent to our hospital after experiencing sudden syncope. She was discharged symptom-free from the hospital 1 day after the procedure (blood pressure, 124/64 mmHg heart rate, 83 bpm), without anticoagulant or antiplatelet treatment. Pericardial effusion (PE) was not evident in the post-procedure transthoracic echocardiography (TTE). A total of 3000 U heparin was given during the procedure. PVCs were no longer observed for a period of 30 min during infusion of isoproterenol (4 μg/min). After termination of PVCs within 1 s, RF delivery continued for up to 90 s at a power setting of 30–40 W with a target temperature of 55 ☌ (Fig. Radiofrequency (RF) current was applied at this location. The earliest activation timing of PVCs was identified on the posterior-lateral wall of the RVOT with a local activation time of 25 ms (Fig. Namely, a roving standard ablation catheter (7 French, 4-mm tip) introduced from the right femoral vein was used for location of the earliest activation site. A single conventional catheter guided by fluoroscopy was selected for mapping and ablation. The electrocardiogram (ECG) morphology of the PVCs suggested a right ventricular outflow tract (RVOT) origin (Fig. This case report demonstrated, for the first time, that very late post-procedural cardiac tamponade might occur after catheter ablation of ventricular arrhythmias, even without antithrombotic treatment.Ī 66-year-old woman without structural heart disease, but with a significant PVC burden of 47% (49,939/105,871 beats), was referred to the Electrophysiology Laboratory for possible catheter ablation of the PVC focus following lack of symptomatic improvement with medical treatment. No signs of pericardial effusion recurred in a follow-up time of 12 months. The patient was discharged after a 2-week hospitalization for investigating other probable causes with negative results. Following an emergent pericardiocentesis to drain a 200 mL hemorrhagic effusion, the patient’s hemodynamics improved significantly. Transthoracic echocardiography revealed hemorrhagic cardiac tamponade, which was considered due to a delayed tiny perforation in the heart induced by the previous ablation. ![]() Upon arriving at our hospital, she was “confused and shock”. Nineteen days after ablation, the patient experienced sudden syncope. Case presentationĪ 66-year-old woman who underwent successful catheter ablation of right ventricular outflow tract origin premature ventricular complexes. Here, we present a very incredible case about delayed cardiac tamponade after ablation of premature ventricular complexes. It often happens during or shortly after the procedure and needs urgent treatment. There were no performance issues with any abbott devices.Cardiac tamponade is a potentially fatal complication after catheter ablation of ventricular arrhythmias. The patient left the lab stable and was to be discharged the following day. The geometry of the right ventricle was superior and was difficult to cross the valve and access the outflow tract.īecause of the difficult anatomy, all catheters were used in an attempt to map and access the right ventricular outflow tract.īoth the left outflow tract and right ventricle were mapped for a pvc that appeared to be septal on the patient's ecg.ĭuring the procedure, the patient became hypotensive (systolic measurement of 63).Īll catheters were removed, and an echocardiogram revealed a pericardial effusion.Ī drain was placed to stabilize the patient. Related manufacturing ref: 2182269-2021-00078, 2030404-2021-00070.ĭuring a premature ventricular contraction¿s ablation procedure, a pericardial effusion was noted.ĭuring one map collection of geometry and mapping, it was noted that the patient had an unusual anatomy a pfi (patellofemoral instability) was present and the right ventricle was difficult to access with the ablation catheter. ![]()
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