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Metzner A, Reubold SD, Schönhofer S, Reißmann B, Ouyang F, Rottner L, Schleberger R, Dinshaw L, Moser J, Moser F, Lemoine M, Münkler P, Kany S, Steven D, Sommer P, Kirchhof P, Rillig A. Management of pericardial tamponade in the electrophysiology laboratory: results from a national survey. Clin Res Cardiol 2023; 112:1727-1737. [PMID: 35713695 PMCID: PMC10697891 DOI: 10.1007/s00392-022-02042-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/11/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite continued efforts to improve the safety of catheter ablation, pericardial tamponade remains one of its more frequent, potentially life-threatening complications. Management of cardiac tamponade is not standardized and uncertainties regarding acute treatment remain. METHODS This survey sought to evaluate the management of cardiac tamponade in German EP centers via a standardized postal questionnaire. All 341 identified German EP centers were invited to return a questionnaire on their standards for the management of cardiac tamponade. RESULTS A total of 189 German EP centers completed the questionnaire. Several precautions are followed to avoid pericardial tamponade: A minority of centers preclude very old patients (19%) or those with a high body mass index (30%) from ablation. Non-vitamin K antagonist oral anticoagulants are briefly paused in most centers (88%) before procedures, while vitamin K antagonists are continued. Pericardial tamponade is usually treated using reversal of heparin by applying protamine (86%) and pericardiocentesis under both, fluoroscopic and echocardiographic guidance (62%). A pigtail catheter is mostly inserted (97%) and autotransfusion of aspirated blood is performed in 47% of centers. The decision for surgical repair depends on different clinical and infrastructural aspects. The timing of reinitiation of anticoagulation widely differs between the centers. Approximately 1/3 of centers prescribe nonsteroidal anti-inflammatory agents, colchicine or steroids after pericardiocentesis. CONCLUSION The present survey shows that the management of cardiac tamponade is still inhomogeneous in German ablation centers. However, multiple findings of this survey can be generalized and might guide especially less experienced operators and centers in their treatment and decision strategies.
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Affiliation(s)
- Andreas Metzner
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany.
- DZHK, Hamburg, Germany.
- DZHK, Kiel, Germany.
- DZHK, Lübeck, Germany.
| | - Stephan D Reubold
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
- DZHK, Hamburg, Germany
- DZHK, Kiel, Germany
- DZHK, Lübeck, Germany
| | | | - Bruno Reißmann
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
- DZHK, Hamburg, Germany
- DZHK, Kiel, Germany
- DZHK, Lübeck, Germany
| | - Feifan Ouyang
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
- DZHK, Hamburg, Germany
- DZHK, Kiel, Germany
- DZHK, Lübeck, Germany
| | - Laura Rottner
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
- DZHK, Hamburg, Germany
- DZHK, Kiel, Germany
- DZHK, Lübeck, Germany
| | - Ruben Schleberger
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
- DZHK, Hamburg, Germany
- DZHK, Kiel, Germany
- DZHK, Lübeck, Germany
| | - Leon Dinshaw
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
- DZHK, Hamburg, Germany
- DZHK, Kiel, Germany
- DZHK, Lübeck, Germany
| | - Julia Moser
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
- DZHK, Hamburg, Germany
- DZHK, Kiel, Germany
- DZHK, Lübeck, Germany
| | - Fabian Moser
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
- DZHK, Hamburg, Germany
- DZHK, Kiel, Germany
- DZHK, Lübeck, Germany
| | - Marc Lemoine
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
- DZHK, Hamburg, Germany
- DZHK, Kiel, Germany
- DZHK, Lübeck, Germany
| | - Paula Münkler
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
- DZHK, Hamburg, Germany
- DZHK, Kiel, Germany
- DZHK, Lübeck, Germany
| | - Shinwan Kany
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
- DZHK, Hamburg, Germany
- DZHK, Kiel, Germany
- DZHK, Lübeck, Germany
| | - Daniel Steven
- University Heart Center, University of Cologne, Cologne, Germany
| | - Philipp Sommer
- Herz- Und Diabeteszentrum NRW, Bad Oeynhausen, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Andreas Rillig
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
- DZHK, Hamburg, Germany
- DZHK, Kiel, Germany
- DZHK, Lübeck, Germany
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Rottner L, Reubold S, Schönhofer S, Reißmann B, Ouyang F, Obergassel J, My I, Moser F, Wenzel J, Lemoine M, Steven D, Sommer P, Kirchhof P, Rillig A, Metzner A. The infrastructure of electrophysiology centers impacts the management of cardiac tamponade-Results from a national survey. Clin Cardiol 2023; 46:1210-1219. [PMID: 37526378 PMCID: PMC10577558 DOI: 10.1002/clc.24096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/27/2023] [Accepted: 07/13/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Although electrophysiological (EP) centers have institutional standards, evidence on management of cardiac tamponade is lacking. AIM AND METHODS A physician-based survey was conducted by sending out questionnaires to all hospitals in Germany performing EP procedures. To evaluate the infrastructure of EP centers and the impact of center volume and onsite cardiac surgery on the management of cardiac tamponade, the results of the survey were analyzed for low-volume (0-250 procedures per year), mid-volume (250-500 procedures), and high-volume (>500 procedures) centers, as well as for centers with and without onsite cardiac surgery. RESULTS A total of 341 centers were identified and 189/341 (55%) returned data sets were analyzed. Most types of EP procedures are performed across all kinds of centers. Ablation of ventricular tachycardia (VT) is concentrated in higher volume centers and in centers with onsite cardiac surgery. None of the participating low-volume centers and only 13% of centers without onsite cardiac surgery responded to performing epicardial VT ablation. Irrespective of center volume and onsite cardiac surgery, neither body mass index nor age was reported to be an exclusion criterion for ablation procedures. Higher volume centers and centers with onsite cardiac surgery more often have dedicated EP laboratories and EP-nursing teams. Also, differences regarding periprocedural safety precautions and management of cardiac tamponade were found for low-, mid-, and high-volume centers, as well as for centers with and without onsite cardiac surgery. CONCLUSION While center volume and onsite cardiac surgery do not impact patient selection, there are differences in ablation spectrum, infrastructure, periprocedural safety precautions, and treatment of tamponade.
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Affiliation(s)
- Laura Rottner
- Department of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
| | - Stefan Reubold
- Department of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
| | | | - Bruno Reißmann
- Department of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
| | - Feifan Ouyang
- Department of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
| | - Julius Obergassel
- Department of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
| | - Ilaria My
- Department of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
| | - Fabian Moser
- Department of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
| | - Jan‐Per Wenzel
- Department of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
| | - Marc Lemoine
- Department of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
| | - Daniel Steven
- University Heart Center, University of CologneCologneGermany
| | - Philipp Sommer
- Herz‐ und Diabeteszentrum NRW, Bad Oeynhausen, Ruhr‐University of BochumBad OeynhausenGermany
| | - Paulus Kirchhof
- Department of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
- DZHK, partner site Hamburg/Kiel/LübeckHamburgGermany
- Institute of Cardiovascular SciencesUniversity of BirminghamBirminghamUK
| | - Andreas Rillig
- Department of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
| | - Andreas Metzner
- Department of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
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Duncker D, Dahme T, Deisenhofer I, Hillmann HAK, Kantenwein V, Müller-Leisse J, Palacios D, Pott A, Reents T, Schmitt J, Veltmann C, Zormpas C, Johnson V. [It's all over! : Complications in the EP lab and their solutions]. Herzschrittmacherther Elektrophysiol 2020; 31:401-413. [PMID: 32880705 DOI: 10.1007/s00399-020-00716-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
In cardiac electrophysiology, invasive procedures like catheter ablations or device implantations are getting increasingly complex. This poses challenges especially for electrophysiologists in training, not only to learn how to perform the procedure, but also how to manage possible complications. The present article uses exemplary case studies to present how to control complications and how to avoid them. The presented cases deal with complications such as air embolism in left atrial procedures, iatrogenic vascular injuries such as aortic dissection or dissection of the coronary sinus, complications and challenges with lead revisions, and pericardial tamponade. In each case, measures for avoidance as well as practical guidance for management are shown when the respective complication occurs.
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Affiliation(s)
- David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - Tilman Dahme
- Klinik für Innere Medizin II, Kardiologie, Angiologie, Pneumologie, internistische Intensivmedizin, Rehabilitations- und Sportmedizin, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Isabel Deisenhofer
- Abteilung für Elektrophysiologie, Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Klinik an der Technischen Universität München, München, Deutschland
| | - Henrike A K Hillmann
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Verena Kantenwein
- Abteilung für Elektrophysiologie, Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Klinik an der Technischen Universität München, München, Deutschland
| | - Johanna Müller-Leisse
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Daniel Palacios
- Klinikfür Herz‑, Kinderherz- und Gefäßchirurgie, Abteilung Gefäßchirurgie, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Alexander Pott
- Klinik für Innere Medizin II, Kardiologie, Angiologie, Pneumologie, internistische Intensivmedizin, Rehabilitations- und Sportmedizin, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Tilko Reents
- Abteilung für Elektrophysiologie, Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Klinik an der Technischen Universität München, München, Deutschland
| | - Jörn Schmitt
- Medizinische Klinik I, Abteilung Kardiologie, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Christian Veltmann
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Christos Zormpas
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Victoria Johnson
- Medizinische Klinik I, Abteilung Kardiologie, Universitätsklinikum Gießen, Gießen, Deutschland
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