Surgical management for cardiac tamponade following atrial fibrillation radiofrequency ablation

Yu Jianbo; Lai Yongqiang

doi:10.3760/j.issn.1673-4777.2020.01.010

Abstract：Objective To investigate the clinical experience of surgical thoracotomy for cardiac tamponade following radiofrequency ablation for atrial fibrillation.Methods From January 2008 to June 2018,31 patients had cardiac tamponade during or after atrial fibrillation radiofrequency catheter ablation and required surgical treatment in Beijing Anzhen Hospital,Capital Medical University.Clinical record of the patients were retrospectively analyzed.Manifestations of cardiac tamponade and surgical methods were analyzed.Results Locations of cardiac injury in 31 patients were inferior vena cava(1 case,3.2％),right atrium(3 cases,9.6％),right ventricle(13 cases,41.9％) and left atrium(14 cases,45.2％).With the guidance of X-ray fluoroscopy,pericardial puncture and drainage were performed through thoracotomy to clear pericardial blood clot,suture perforated site and stop bleeding.Two patients died of multiple organ failure in 1-3 days after surgery.In 29 survival patients,postoperative intensive care unit stay time was 1-16 days[mean (3.0 ± 1.8)d];postoperative hospital stay time was 10-24 d[mean (12 ± 7)d].Postoperative complications included 1 case of lower extremity venous thrombosis,3 cases of pulmonary infection and 1 case of renal failure;all patients recovered well after treatments.Conclusions Cardiac tamponade is a fatal complication following atrial fibrillation radiofrequency ablation.Pericardial puncture and drainage should be performed urgently.Pericardial repair through surgical thoracotomy should be performed in patients with persistent unstable hemodynamics.