B-AB10-02 CONTINUOUS PERICARDIAL IRRIGATION-SUCTION TECHNIQUE TO MANAGE SEVERE PERICARDIAL EFFUSION

Abstract

Intraprocedural hemorrhagic pericardial effusion (HPE) is typically managed with reversal of systemic anticoagulation and pericardiocentesis. In case of severe HPE with rapid bleeding, loculated clot may form in the pericardium around the pericardial drain/sheath, preventing adequate drainage and leading to rapid hemodynamic collapse. We describe a novel technique of continuous pericardial saline irrigation and suction (CP-IS) from two separate pericardial sites to prevent loculated intrapericardial clot formation and manage severe HPE. Retrospective review of cases of intraprocedural severe HPE with rapid bleeding treated with a CP-IS technique guided by intracardiac echocardiography (ICE). Six patients (age 72±7 years, 4 females) with severe HPE during catheter ablation of AF/AFL (n=2), VT (n=1), LAA closure (n=2) or ICD implantation (n=1) were treated with CP-IS from two separate pericardial sites via either two access sheaths (8.5 Fr deflectable) or one sheath (8 Fr deflectable) and a pigtail catheter (7 Fr). Following full heparin reversal (oral anticoagulation not reversed), complete HPE drainage (mean 650 mL, range 400-1000 mL) and hemodynamic stabilization was achieved in all patients with no residual loculated intrapericardial clot by ICE (Figure). Surgical correction due to persistent bleeding was required in one patient. A CP-IS technique from two separate pericardial sites is effective in managing severe HPE with rapidly accumulating bleeding by preventing intrapericardial loculated clot formation.