Management and outcomes of cardiac tamponade during atrial fibrillation ablation in the presence of therapeutic anticoagulation with warfarin

Rakesh Latchamsetty, Sandeep Gautam, Deepak Bhakta, Aman Chugh, Roy M. John, Laurence M. Epstein, John Miller, Gregory F. Michaud, Hakan Oral, Fred Morady, Krit Jongnarangsin

Research output: Contribution to journalArticle

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Abstract

Background: Cardiac tamponade (CT) is a possible complication of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF). Although the incidence of CT is not higher when RFCA is performed with a therapeutic international normalized ratio (INR), outcomes of CT are unclear. Objective: We compared outcomes among patients with and without a therapeutic INR who developed CT as a complication of RFCA of AF. Methods: The subjects of this retrospective study were 40 consecutive patients who developed CT during RFCA of AF at 3 centers. We divided the patients into 2 groups: RFCA performed with INR < 2 (group 1) and INR < 2 (group 2). There were 23 patients in group 1 and 17 patients in group 2. Results: Baseline clinical and procedure characteristics were not different between the 2 groups. Heparin was reversed by protamine in 83% and 94% of patients (P = .37), and warfarin was reversed by fresh frozen plasma or factor VIIa in 17% and 35% of patients (P = .27) in groups 1 and 2, respectively. All patients were successfully treated by percutaneous drainage, and none required surgical intervention. There were no significant differences in the amount of initial pericardial drainage (523 ± 349 ml vs. 409 ± 157 ml, P = .22) or the duration of drainage (P = .14) between the 2 groups. All patients survived to hospital discharge. Median length of hospital stay was 2 days longer in group 1 (P <.01). Conclusion: Cardiac tamponade is not more severe or difficult to manage in the presence of therapeutic anticoagulation with warfarin in patients undergoing RFCA of AF.

Original languageEnglish
Pages (from-to)805-808
Number of pages4
JournalHeart Rhythm
Volume8
Issue number6
DOIs
StatePublished - Jun 2011

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Cardiac Tamponade
Warfarin
Atrial Fibrillation
Catheter Ablation
International Normalized Ratio
Therapeutics
Drainage
Length of Stay
Factor VIIa
Protamines
Heparin
Retrospective Studies

Keywords

  • Anticoagulation
  • Atrial fibrillation
  • Cardiac tamponade
  • Catheter ablation
  • Complications

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Management and outcomes of cardiac tamponade during atrial fibrillation ablation in the presence of therapeutic anticoagulation with warfarin. / Latchamsetty, Rakesh; Gautam, Sandeep; Bhakta, Deepak; Chugh, Aman; John, Roy M.; Epstein, Laurence M.; Miller, John; Michaud, Gregory F.; Oral, Hakan; Morady, Fred; Jongnarangsin, Krit.

In: Heart Rhythm, Vol. 8, No. 6, 06.2011, p. 805-808.

Research output: Contribution to journalArticle

Latchamsetty, R, Gautam, S, Bhakta, D, Chugh, A, John, RM, Epstein, LM, Miller, J, Michaud, GF, Oral, H, Morady, F & Jongnarangsin, K 2011, 'Management and outcomes of cardiac tamponade during atrial fibrillation ablation in the presence of therapeutic anticoagulation with warfarin', Heart Rhythm, vol. 8, no. 6, pp. 805-808. https://doi.org/10.1016/j.hrthm.2011.01.020
Latchamsetty, Rakesh ; Gautam, Sandeep ; Bhakta, Deepak ; Chugh, Aman ; John, Roy M. ; Epstein, Laurence M. ; Miller, John ; Michaud, Gregory F. ; Oral, Hakan ; Morady, Fred ; Jongnarangsin, Krit. / Management and outcomes of cardiac tamponade during atrial fibrillation ablation in the presence of therapeutic anticoagulation with warfarin. In: Heart Rhythm. 2011 ; Vol. 8, No. 6. pp. 805-808.
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AU - Latchamsetty, Rakesh

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AU - Bhakta, Deepak

AU - Chugh, Aman

AU - John, Roy M.

AU - Epstein, Laurence M.

AU - Miller, John

AU - Michaud, Gregory F.

AU - Oral, Hakan

AU - Morady, Fred

AU - Jongnarangsin, Krit

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N2 - Background: Cardiac tamponade (CT) is a possible complication of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF). Although the incidence of CT is not higher when RFCA is performed with a therapeutic international normalized ratio (INR), outcomes of CT are unclear. Objective: We compared outcomes among patients with and without a therapeutic INR who developed CT as a complication of RFCA of AF. Methods: The subjects of this retrospective study were 40 consecutive patients who developed CT during RFCA of AF at 3 centers. We divided the patients into 2 groups: RFCA performed with INR < 2 (group 1) and INR < 2 (group 2). There were 23 patients in group 1 and 17 patients in group 2. Results: Baseline clinical and procedure characteristics were not different between the 2 groups. Heparin was reversed by protamine in 83% and 94% of patients (P = .37), and warfarin was reversed by fresh frozen plasma or factor VIIa in 17% and 35% of patients (P = .27) in groups 1 and 2, respectively. All patients were successfully treated by percutaneous drainage, and none required surgical intervention. There were no significant differences in the amount of initial pericardial drainage (523 ± 349 ml vs. 409 ± 157 ml, P = .22) or the duration of drainage (P = .14) between the 2 groups. All patients survived to hospital discharge. Median length of hospital stay was 2 days longer in group 1 (P <.01). Conclusion: Cardiac tamponade is not more severe or difficult to manage in the presence of therapeutic anticoagulation with warfarin in patients undergoing RFCA of AF.

AB - Background: Cardiac tamponade (CT) is a possible complication of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF). Although the incidence of CT is not higher when RFCA is performed with a therapeutic international normalized ratio (INR), outcomes of CT are unclear. Objective: We compared outcomes among patients with and without a therapeutic INR who developed CT as a complication of RFCA of AF. Methods: The subjects of this retrospective study were 40 consecutive patients who developed CT during RFCA of AF at 3 centers. We divided the patients into 2 groups: RFCA performed with INR < 2 (group 1) and INR < 2 (group 2). There were 23 patients in group 1 and 17 patients in group 2. Results: Baseline clinical and procedure characteristics were not different between the 2 groups. Heparin was reversed by protamine in 83% and 94% of patients (P = .37), and warfarin was reversed by fresh frozen plasma or factor VIIa in 17% and 35% of patients (P = .27) in groups 1 and 2, respectively. All patients were successfully treated by percutaneous drainage, and none required surgical intervention. There were no significant differences in the amount of initial pericardial drainage (523 ± 349 ml vs. 409 ± 157 ml, P = .22) or the duration of drainage (P = .14) between the 2 groups. All patients survived to hospital discharge. Median length of hospital stay was 2 days longer in group 1 (P <.01). Conclusion: Cardiac tamponade is not more severe or difficult to manage in the presence of therapeutic anticoagulation with warfarin in patients undergoing RFCA of AF.

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KW - Atrial fibrillation

KW - Cardiac tamponade

KW - Catheter ablation

KW - Complications

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