Acute Cardiac Tamponade after Left Sided Premature Ventricular Contraction Ablation

DOI: 10.1515/jce-2016-0012


Introduction: Premature ventricular complex (PVC) is the most common cardiac arrhythmia, which in some circumstances can lead to syncope, arrhythmia-induced cardiomyopathy and sudden death. In idiopathic PVCs, the first choice of treatment is radio-frequency ablation. Identification of the substrate location makes it possible to determine the ablation site, lead- ing to an increased success rate. Complications are related mainly to the ablation technique, peri-procedural anticoagulation therapy, and the access site. Pericardial tamponade is a rare complication. A case in which the ablation procedure of idiopathic PVCs, complicated by cardiac tamponade, is presented in this paper.
Case presentation: A 56-year-old female presented with symptomatic premature ventricular contractions. She had frequent palpitations, dyspnea, and exercise intolerance for ten years. Holter-monitoring demonstrated a total burden of 30,549 PVCs with monomorphic morphol- ogy, and with both bigeminal and trigeminal patterns. Surface ECG suggested a left-sided, left aortic cusp localization of the PVC, with a possible epicardial origin. Three-dimensional map- ping was performed including the RVOT (right ventricular outflow tract) region, aorta, and coronary sinus. The ablation clinical status suggested a cardiac tamponade, which was con- firmed by echocardiography. Radioscopy-controlled pericardial puncture was performed with the extraction of 300 ml of blood. Following this maneuver, the general status of the patient improved. During follow-up checks after twenty-four hours, Holter-monitoring recorded 5000 PVCs with a significant improvement in the clinical status of the patient.
Discussions: Pericardial tamponade after radio-frequency ablation is a rare complication. The risk of tamponade in a right chamber perforation is more dangerous in patients on anticoagula- tion therapy or with pulmonary hypertension. In order to prevent this side effect complication of the interventional procedures, certain safety maneuvers should be followed, including the use of irrigated-type catheters, or when possible, contact force catheters, ensuring invasive arterial blood pressure monitoring during intervention, and after heparin administration and the determination of ACT every twenty minutes. Transthoracic echocardiograph examination and pericardial puncture set should be readily available in the electrophysiology laboratory.