Abstract
Background: Cardiac tamponade is one of the major complications which can result from catheter-based cardiac management, and if its detection or treatment is delayed, it can be fatal. Detecting cardiac tamponade in the earliest possible stages is crucial for preventing its development into a life threatening condition. Methods and results: In this study, an internal blood pressure reading was conducted as part of catheter ablation, cardiac electro physiologic study, and bi-ventricular pacing treatments, and this blood pressure wave form was used along with a FloTrac system to produce a continuous estimate of cardiac output. These data were then retrospectively analyzed to determine whether the FloTrac cardiac output showed changes prior to the onset of declining blood pressure, which is the typical indicator used to diagnose cardiac tamponade. The study was conducted on 213 subjects who were undergoing catheter ablation, cardiac electrophysiologic study, and bi-ventricular pacing treatments. Out of this group, 4 (1.9%) were diagnosed with cardiac tamponade. The FloTrac data for all of these cardiac tamponade subjects showed a decline in stroke volume and cardiac output, with the onset of these changes coming an average of 15.5 ± 6.2 minutes and 8.7 ± 1.0 minutes respectively in advance of the onset of declining blood pressure measurements from the internal blood pressure readings. Conclusion: Continuous cardiac output measurements can be used to detect cardiac tamponade at an earlier stage than continuous internal blood pressure readings, and this could enable accelerated treatment of these complications.
Highlights
In addition topercutaneous coronary intervention for the treatment of angina pectoris and myocardial infarction, percutaneous intracardiac managements for atrial fibrillation such as catheter ablation, closure of atrial and ventricular septal defects and patent foramen ovale, percutaneous heart valvular repair and replacement and left appendage occlusion, as well as bi-ventricular pacing, have started to be performed in recent years
We hypothesized that stroke volume and cardiac output can reflect the changes of cardiac performance by cardiac tamponade sensitively, compared to blood pressure more affected by influence of peripheral arterial resistance
This study considered whether this continuous cardiac performance data could be used as a simple and low-cost system for early detection of cardiac tamponade
Summary
An internal blood pressure reading was conducted as part of catheter ablation, cardiac electro physiologic study, and bi-ventricular pacing treatments, and this blood pressure wave form was used along with a FloTrac system to produce a continuous estimate of cardiac output. These data were retrospectively analyzed to determine whether the FloTrac cardiac output showed changes prior to the onset of declining blood pressure, which is the typical indicator used to diagnose cardiac tamponade. The FloTrac data for all of these cardiac tamponade subjects showed a decline in stroke volume and cardiac output, with the onset of these changes coming an average of 15.5 ± 6.2 minutes and 8.7 ± 1.0 minutes respectively in advance of the onset of declining blood pressure measurements from the internal blood pressure readings
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