Episodes Of Cardiac Tamponade Research Articles

Cardiac Tamponade, First Sign of Onset of Systemic Lupus Erythematosus

Abstract Systemic lupus erythematosus (SLE) is an autoimmune disease with various clinical manifestations that can affect multiple organs and systems. One of the severe complications associated with SLE is cardiac tamponade, a rare and life-threatening complication. In this paper, we present the case of a 36-year-old woman who was diagnosed with SLE after an episode of cardiac tamponade. Large pericardial effusions with cardiac tamponade are rarely encountered in SLE, particularly as the onset of the disease. This case highlights the importance of early recognition of cardiac tamponade and raises awareness of the fact that SLE can present with cardiac involvement, such as cardiac tamponade, at the onset of the disease. Multidisciplinary care involving rheumatologists, cardiologists, and other specialists is essential in the management of SLE with cardiac complications.

Percutaneous Balloon Pericardiotomy and Window Creation for Treating Recurrent Massive Pericardial Effusion in Patients with Cancer: A Case Series and Literature Review

Cancer is the second leading cause of death worldwide, and pericardial effusion is relatively common in these patients. What constitutes the best therapeutic method for treating pericardial effusion in patients with cancer is controversial. Recent decades have witnessed the introduction of percutaneous balloon pericardiotomy, an effective and less-invasive method with lower recurrence rates than pericardiocentesis for draining pericardial effusion in patients with cancer who have a poor prognosis.We herein describe 2 patients with a history of metastatic melanoma and metastatic breast cancer, presenting with symptomatic massive pericardial effusions. The patients had experienced 2 episodes of cardiac tamponade in the preceding 4 to 5 months, treated via surgical drainage. In their current episode, they were both successfully treated via percutaneous balloon pericardiotomy, and there was no recurrence of significant pericardial effusion reported during the follow-up.

Influence of ablation index on the incidence of cardiac tamponade complicating pulmonary vein isolation.

Cardiac tamponade (CT) complicating pulmonary vein isolation (PVI) for atrial fibrillation (AF) is acomplication that can increase morbidity and mortality. Radiofrequency energy is aknown cause of CT. Ablation Index (AI) is anovel ablation quality marker. We hypothesized that use of AI reduces the incidence of CT. All AF procedures between 10/2014 and 06/2019 were included. Three ablation groups were defined: groupA, RF ablation with non-contact force (CF) catheter; groupB, RF ablation with CF catheter; and groupC, RF ablation with CF catheter using AI. All episodes of CT were analyzed. In total, 1222consecutive AF patients underwent PVI. GroupA consisted of 100 (8%) procedures, while groupB included 432 (35%) procedures and groupC 690 (57%) procedures. The overall risk for CT in all patients was 2.1% (26/1222). The risk in groupA was 2.9% (3/100), in groupB 2.5% (11/432), and in groupC 1.7% (12/690), including all 1222patients in the analysis (p < 0.05). Univariate analysis identified no further specific predictors for CT. With the exception of one patient (1/26; 3.8%), who needed surgical treatment, all CT could be successfully drained. In ahigh-volume center, the use of AI decreased the risk of CT in patients undergoing RF ablation for AF by 32%.

Safety and efficacy of contemporary catheter ablation for atrial fibrillation patients with a history of cardioembolic stroke in the era of direct oral anticoagulants

BackgroundThe safety and efficacy of the contemporary atrial fibrillation (AF) ablation in patients with a recent or previous history of cardioembolic stroke (CS) or transient ischemic attack (TIA) remain to be established. MethodsA total of 447 patients who underwent first-ever contact force (CF)-guided AF ablation with circumferential pulmonary vein isolation were included. Of these, 17 had CS or TIA within 6 months before ablation (Group 1), 30 more than 6 months before ablation (Group 2), and the other 400 without CS or TIA (Group 3). Procedural complications and recurrence of AF and atrial tachyarrhythmias were compared among the 3 groups. ResultsThe mean age was 71±7, 66±9, and 61±11 years in Groups 1, 2, and 3, respectively (p<0.05, Group 1 versus Group 3). The oral anticoagulants were warfarin (n=108, 24.1%), dabigatran (n=101, 22.6%), rivaroxaban (n=147, 32.9%), apixaban (n=87, 19.5%), and edoxaban (n=4, 0.9%), and did not differ among the 3 groups. Median follow-up period was 14 [IQR 12–22], 13 [12–14], and 12 [10–16] months, respectively. One episode of cardiac tamponade, 2 episodes of arteriovenous fistula, and some minor complications occurred in Group 3, but no complications occurred in Groups 1 and 2 in the periprocedural period. Although one episode of CS occurred 11 days after the procedure in Group 3, there were no periprocedural CS, TIA, or major bleedings in Groups 1 and 2. AF recurrence-free rate after the procedure was 76.5%, 86.7%, and 79.1% in Groups 1, 2, and 3, respectively, and there was no difference in Kaplan–Meier curves among the 3 groups. ConclusionThe safety and efficacy of CF-guided AF ablation in the era of direct oral anticoagulants in patients with a recent or previous history of CS or TIA are similar to those in patients without it.

A Case Of Difficult Epicardial Access For Ablation Of Ventricular Tachcyardia.

We present a case of a 67-year-old patient with nonischemic cardiomyopathy and recurrent sustained ventricular tachycardia of epicardial origin referred for ablation. Due to two previous episodes of cardiac tamponade secondary to implantable cardioverter-defibrillator lead perforation at the time of device implant, the patient had significant pericardial adhesions making epicardial access and ablation challenging.

Pacemaker or Defibrillator Surgery without Interruption of Anticoagulation

BackgroundMany patients requiring pacemaker or implantable cardioverter–defibrillator (ICD) surgery are taking warfarin. For patients at high risk for thromboembolic events, guidelines recommend bridging therapy with heparin; however, case series suggest that it may be safe to perform surgery without interrupting warfarin treatment. There have been few results from clinical trials to support the safety and efficacy of this approach.MethodsWe randomly assigned patients with an annual risk of thromboembolic events of 5% or more to continued warfarin treatment or to bridging therapy with heparin. The primary outcome was clinically significant device-pocket hematoma, which was defined as device-pocket hematoma that necessitated prolonged hospitalization, interruption of anticoagulation therapy, or further surgery (e.g., hematoma evacuation).ResultsThe data and safety monitoring board recommended termination of the trial after the second prespecified interim analysis. Clinically significant device-pocket hematoma occurred in 12 of 343 patients (3.5%) in the continued-warfarin group, as compared with 54 of 338 (16.0%) in the heparin-bridging group (relative risk, 0.19; 95% confidence interval, 0.10 to 0.36; P<0.001). Major surgical and thromboembolic complications were rare and did not differ significantly between the study groups. They included one episode of cardiac tamponade and one myocardial infarction in the heparin-bridging group and one stroke and one transient ischemic attack in the continued-warfarin group.ConclusionsAs compared with bridging therapy with heparin, a strategy of continued warfarin treatment at the time of pacemaker or ICD surgery markedly reduced the incidence of clinically significant device-pocket hematoma. (Funded by the Canadian Institutes of Health Research and the Ministry of Health and Long-Term Care of Ontario; BRUISE CONTROL ClinicalTrials.gov number, NCT00800137.)

Large pericardial effusion as a life-threatening complication after hematopoietic stem cell transplantation—association with chronic GVHD in late-onset adult patients

Large pericardial effusion (LPE) with cardiac tamponade is a rare but life-threatening complication in adults undergoing hematopoietic stem cell transplantation (HSCT). The incidence and pathophysiology have not been well defined. We retrospectively reviewed 601 patients (≧18years of age) receiving HSCT (262 autologous, 189 siblings, and 150 unrelated donors) in our center from January 2001 to September 2011. We described the incidence, clinical characteristics, treatment, and outcome. In total, six patients (0.998%) developed seven episodes (1.16%) of LPEs with cardiac tamponade. One patient underwent unrelated allografts and the other five patients received sibling allografts. The median day of detecting LPE were 176 in the six patients and 241 in the four late-onset patients (range, 9-369). All patients had normal cardiac function before HSCT. Two patients developed LPE early after conditioning, considered as cardiac toxicity resulting from high-dose cyclophosphamide. Four patients had chronic graft-versus-host disease (GVHD) involving lung, skin and sicca syndrome concomitant with or preceding the development of LPE. All episodes of cardiac tamponade were effectively managed by pericardiocentesis and enhanced immunosuppression. In conclusion, LPE and cardiac tamponade may develop after allogeneic HSCT, either with sibling or matched unrelated donor. The etiology is probably related to chronic GVHD in cases of late onset. Emergent pericardiocentesis and enhanced immunosuppression can effectively control this life-threatening complication.

Visually-Guided Balloon Catheter Ablation of Atrial Fibrillation

Electric isolation of the pulmonary veins (PVs) can successfully treat patients with paroxysmal atrial fibrillation. However, it remains technically challenging to identify the left atrial-PV junction and sequentially position the ablation catheter in a point-by-point contiguous fashion to isolate the PVs. In this study, a novel endoscopic ablation system was used to directly visualize and ablate tissue at the left atrial-PV junction with laser energy. This study consisted of 2 phases: a short-term (n=9) and long-term (n=11) canine experimental validation phase and a multicenter clinical feasibility phase (n=30 paroxysmal atrial fibrillation patients). After transseptal puncture, the balloon-based endoscopic ablation system was advanced to each PV ostium, and arcs of laser energy (90 degrees to 360 degrees ) were projected onto the target left atrial-PV junction. Electric PV isolation was defined with a circular multielectrode catheter. In the short-term preclinical experimental phase, 15 of 17 targeted PVs (88%) were successfully isolated. Pathological examination revealed well-demarcated circumferential lesions with minimal endothelial disruption. In the long-term experiments, 9 of 10 targeted veins (90%) remained persistently isolated (at 4 to 8 weeks). In the clinical phase, 105 of 116 PVs (91%) were successfully isolated. After a single procedure, the 12-month drug-free rate of freedom from atrial fibrillation was 60% (18 of 30 patients). There were no significant PV stenoses, but adverse events included 1 episode of cardiac tamponade, 1 stroke without residual defect, and 1 asymptomatic phrenic nerve palsy. This study establishes the feasibility of a novel paradigm for AF ablation: direct visualization to guide catheter ablation of the left atrial-PV junction.

Clinical experience with expanded polytetrafluoroethylene Gore-Tex surgical membrane for pericardial closure: a study of 110 cases.

Complete closure of the pericardium after cardiac operations has the advantage of avoiding injury of the heart and great vessels during reoperation. Between 1985 and 1987, the pericardium was closed with Gore-Tex Surgical Membrane (SM) in a selected series of 110 patients 1 month to 76 years of age. Fifty-three patients had congenital heart lesions and 57 patients had acquired heart disease. Overall hospital mortality was 3/110 cases. In no instance was there a relationship between occurrence of death and pericardial closure with SM. There was one episode of cardiac tamponade on the seventh postoperative day. One patient developed fever and leukocytosis due to a mediastinal hematoma. During a mean follow-up of 15 months, four patients had to be reoperated upon three, four, eight weeks, and eight months after primary operation. The anterior wall of the heart had no adhesion with the SM and the other parts of pericardium could be dissected easily. Scanning electron microscopic examination of the explanted SM patches showed neither cellular ingrowth nor immunocompetent cellular elements. The Gore-Tex Surgical Membrane has the advantages of easy availability and lack of reaction between its surface and the epicardium and pericardium. We believe its routine use should be encouraged in patients with high probability of reoperation after repair of complex cardiac anomalies, implantation of bioprostheses, coronary revascularization for one- or two-vessel disease, and repair of degenerative disease of the ascending aorta.