2024 FSA Podium and Poster Abstracts
P103: ACUTE CARDIAC TAMPONADE AFTER ABLATION THERAPY IN PATIENT WITH ATRIAL FIBRILLATION
Aaron Hacker1; Tarun Uppalapati1; Joseph Sluhoski1; Skylar R Harmon2; 1HCA Westside Hospital; 2Dr. Kiran C. Patel College of Allopathic Medicine
Introduction/Background: Complications of atrial fibrillation ablation can include pericardial effusion, which can occur acutely. Large and hemodynamically significant effusions are uncommon. Small effusions may present at end of procedure in up to 22% ablations. In a 15-year single-center study of 5222 catheter ablations of atrial fibrillation, cardiac tamponade complicated 51 procedures (1%).
Methods: A 66-year-old morbidly obese (BMI 51.2) female presented to the hospital for ablation therapy for her atrial fibrillation. She had a previous TEE cardioversion therapy in February 2023. Her past medical history includes hypertension, coronary artery disease, atrial fibrillation, functional capacity less than 4 mets, valvular heart disease (moderate mitral regurgitation w/ EF 55%), COPD, recent COVID infection in late 2022, GERD, hiatal hernia, and morbid obesity. Past surgical history includes cholecystectomy, cardiac cath 2018, cardioversion, and tonsillectomy. Post procedure, patient was brought to PACU and complained of shortness of breath. Patient was put on BiPAP eventually. Due to increasing respiratory failure, patient was emergently intubated in PACU. Patient had a central line placed with dopamine started as a vasopressor. Patient had a bedside TEE that showed moderate pericardial effusion. Cardiologist was consulted and tried to place a pericardial drain which was unsuccessful due to patient body habitus. Patient was emergently taken to cath lab where a pericardial drain was successfully placed and confirmed with immediate drainage of bloody fluid. Patient was transported to ICU soon after.
Results: Patient had 200cc drainage on POD0. On POD1, patient had 250cc drainage and patient was on 3mcg of dopamine. CTS said no intervention was needed and patient was extubated soon after. On POD2, there was no drainage and patient weaned off dopamine. On POD3, drain was removed with patient feeling better without issues and was able to ambulate with physical therapy. On POD4, patient was discharged.
Discussion/Conclusion: This patient presented to PACU with acute respiratory failure from acute cardiac tamponade. Due to patient becoming hemodynamically unstable, she required dopamine to maintain blood pressure. Patient had immediate improvement of vitals soon after pericardial drainage of fluid. A systematic review of pericarditis associated with COVID-19 included 34 patients, who reported pericardial effusions in 76% and cardiac tamponade in 35%. Patient history of recent COVID infection could have led to a severe pericardial effusion. There could be residual scarring that could have decreased contractility slightly. Patient had an intra-cardiac echocardiogram throughout the procedure that did not detect pericardial effusion. Patient met extubation criteria and was extubated at the end of procedure. Pleural effusion could have been minimal at the time. Obese patients require an increased cardiac output to meet metabolic demand of excess adipose tissue. Therefore, effects from cardiac tamponade and reduced cardiac function may have faster onset of clinical effects in obese patients compared to non-obese patients.