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Morales JP, Spaccavento A, Ordoñez S, Baro R, Conde D, Costabel JP. Intra-pericardial thrombin injection in iatrogenic cardiac tamponade: a case report. Egypt Heart J 2024; 76:28. [PMID: 38407742 PMCID: PMC10897110 DOI: 10.1186/s43044-024-00459-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/21/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Nowadays, percutaneous procedures are expanding in use, and this comes with complications associated with the procedure itself. Cardiac tamponade is rare but may be life threatening since it can involve hemodynamic instability. It is known that after pleural effusion during a percutaneous procedure, pericardiocentesis should be used as drainage of the cavity. However, that does not achieve hemostasis in some cases, and in those patients who are hemodynamically unstable, a sealing agent to promote hemostasis might be useful, like thrombin. CASE PRESENTATION We present a case report of 89-year-old patient with history of melanoma undergoing treatment with pembrolizumab, who attended the emergency department referring chest pain (intensity 5/10) and palpitations that have lasted hours. He had TnTUs 554/566 ng/L and an echocardiogram that showed dilated right chambers, hypertrophy and global hypokinesia of the left ventricle, increased filling pressures of the left ventricle and pulmonary hypertension. Myocarditis associated with pembrolizumab was suspected, so high dose steroids were initiated and endomyocardial biopsy was conducted, resulting in iatrogenic cardiac tamponade. To determine the etiology of the suspected myocarditis, an endomyocardial biopsy was performed. Unfortunately, an intraprocedural complication arose: pleural effusion resulting in iatrogenic cardiac tamponade, leading to hemodynamic instability. It required immediate pericardial drainage via subxiphoid puncture, obtaining a 550 mL hematic debit. Clinical manifestations raised suspicion of tamponade, prompting a bedside echocardiogram for a definitive diagnosis. Despite these efforts, the patient remained hemodynamically unstable, and due to the elevated surgical risk, intrapericardial thrombin was employed to achieve successful hemostasis. CONCLUSIONS Cardiac tamponade is a life-threatening condition that can sometimes be induced iatrogenically, resulting from percutaneous interventions. Despite limited evidence regarding this therapeutic strategy, in patients experiencing iatrogenic cardiac tamponade with hemodynamic instability and high surgical risk, the administration of intra-pericardial thrombin could be contemplated.
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Affiliation(s)
- Juana Perez Morales
- Department of Cardiology at Instituto Cardiovascular de Buenos Aires, Av. del Libertador 6302, 1428, Buenos Aires, Argentina
| | - Ana Spaccavento
- Department of Cardiology at Instituto Cardiovascular de Buenos Aires, Av. del Libertador 6302, 1428, Buenos Aires, Argentina
| | - Santiago Ordoñez
- Department of Cardiology at Instituto Cardiovascular de Buenos Aires, Av. del Libertador 6302, 1428, Buenos Aires, Argentina
| | - Rocío Baro
- Department of Cardiology at Instituto Cardiovascular de Buenos Aires, Av. del Libertador 6302, 1428, Buenos Aires, Argentina
| | - Diego Conde
- Department of Cardiology at Instituto Cardiovascular de Buenos Aires, Av. del Libertador 6302, 1428, Buenos Aires, Argentina.
| | - Juan Pablo Costabel
- Department of Cardiology at Instituto Cardiovascular de Buenos Aires, Av. del Libertador 6302, 1428, Buenos Aires, Argentina
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Eckardt L, Doldi F, Anwar O, Gessler N, Scherschel K, Kahle AK, von Falkenhausen AS, Thaler R, Wolfes J, Metzner A, Meyer C, Willems S, Köbe J, Lange PS, Frommeyer G, Kuck KH, Kääb S, Steinbeck G, Sinner MF. Major in-hospital complications after catheter ablation of cardiac arrhythmias: individual case analysis of 43 031 procedures. Europace 2023; 26:euad361. [PMID: 38102318 PMCID: PMC10754182 DOI: 10.1093/europace/euad361] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023] Open
Abstract
AIMS In-hospital complications of catheter ablation for atrial fibrillation (AF), atrial flutter (AFL), and ventricular tachycardia (VT) may be overestimated by analyses of administrative data. METHODS AND RESULTS We determined the incidences of in-hospital mortality, major bleeding, and stroke around AF, AFL, and VT ablations in four German tertiary centres between 2005 and 2020. All cases were coded by the G-DRG- and OPS-systems. Uniform code search terms were applied defining both the types of ablations for AF, AFL, and VT and the occurrence of major adverse events including femoral vascular complications, iatrogenic tamponade, stroke, and in-hospital death. Importantly, all complications were individually reviewed based on patient-level source records. Overall, 43 031 ablations were analysed (30 361 AF; 9364 AFL; 3306 VT). The number of ablations/year more than doubled from 2005 (n = 1569) to 2020 (n = 3317) with 3 times and 2.5 times more AF and VT ablations in 2020 (n = 2404 and n = 301, respectively) as compared to 2005 (n = 817 and n = 120, respectively), but a rather stable number of AFL ablations (n = 554 vs. n = 612). Major peri-procedural complications occurred in 594 (1.4%) patients. Complication rates were 1.1% (n = 325) for AF, 1.0% (n = 95) for AFL, and 5.3% (n = 175) for VT. With an increase in complex AF/VT procedures, the overall complication rate significantly increased (0.76% in 2005 vs. 1.81% in 2020; P = 0.004); but remained low over time. Following patient-adjudication, all in-hospital cardiac tamponades (0.7%) and strokes (0.2%) were related to ablation. Major femoral vascular complications requiring surgical intervention occurred in 0.4% of all patients. The in-hospital mortality rate adjudicated to be ablation-related was lower than the coded mortality rate: AF: 0.03% vs. 0.04%; AFL: 0.04% vs. 0.14%; VT: 0.42% vs. 1.48%. CONCLUSION Major adverse events are low and comparable after catheter ablation for AFL and AF (∼1.0%), whereas they are five times higher for VT ablations. In the presence of an increase in complex ablation procedures, a moderate but significant increase in overall complications from 2005-20 was observed. Individual case analysis demonstrated a lower than coded ablation-related in-hospital mortality. This highlights the importance of individual case adjudication when analysing administrative data.
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Affiliation(s)
- Lars Eckardt
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer -Campus 1, 48149 Münster, Germany
| | - Florian Doldi
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer -Campus 1, 48149 Münster, Germany
| | - Omar Anwar
- Asklepios Hospital St.Georg, Department of Cardiology and Internal Intensive Care Medicine, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Nele Gessler
- Asklepios Hospital St.Georg, Department of Cardiology and Internal Intensive Care Medicine, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Katharina Scherschel
- Klinik für Kardiologie, Angiologie, Intensivmedizin, cNEP Research Consortium EVK, Düsseldorf, Germany
| | - Ann-Kathrin Kahle
- Klinik für Kardiologie, Angiologie, Intensivmedizin, cNEP Research Consortium EVK, Düsseldorf, Germany
| | - Aenne S von Falkenhausen
- Department of Cardiology, University Hospital, LMU Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - Raffael Thaler
- Department of Cardiology, University Hospital, LMU Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - Julian Wolfes
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer -Campus 1, 48149 Münster, Germany
| | - Andreas Metzner
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Berlin, Germany
- Klinik und Poliklinik für Kardiologie, Universitäres Herz- und Gefäßzentrum UKE Hamburg, Hamburg, Germany
| | - Christian Meyer
- Klinik für Kardiologie, Angiologie, Intensivmedizin, cNEP Research Consortium EVK, Düsseldorf, Germany
| | - Stephan Willems
- Asklepios Hospital St.Georg, Department of Cardiology and Internal Intensive Care Medicine, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Julia Köbe
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer -Campus 1, 48149 Münster, Germany
| | - Philipp Sebastian Lange
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer -Campus 1, 48149 Münster, Germany
| | - Gerrit Frommeyer
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer -Campus 1, 48149 Münster, Germany
| | - Karl-Heinz Kuck
- Asklepios Hospital St.Georg, Department of Cardiology and Internal Intensive Care Medicine, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Stefan Kääb
- Department of Cardiology, University Hospital, LMU Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - Gerhard Steinbeck
- Department of Cardiology, University Hospital, LMU Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - Moritz F Sinner
- Department of Cardiology, University Hospital, LMU Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany
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