Clinical analysis of patients with acute cardiac tamponade during rad iofrequency catheter ablation procedure

Objective To provide clinical experience in the t reatment and prevention of complicated acute cardiac tamponade in the course of radiofrequency ablation (RFCA) in patients with tachyarrhythmias.Met hod To analyse the clinical features of patients with acute cardiac tam ponade and to investigate the possible underlying mechanism.Results There were 4 (0 48%) patients complicated with acute cardiac tamponade in 850 patients undergoing RFCA Of the 4 patients,3 were more than 65 years old,th e other one was a 8- year-old child Electrophysiological study indicated t hat t he underlying mechanism of tachycardia in all the 4 patients were left-side acc essory pathways,2 were anterior and 2 posterior pathways Coronary sinus mapping catheter was routinely inserted and ablation catheter was positioned retrograde l y through aortic valve Unfractionade heparin was administered in all patients when cardiac tamponade was diagnosed,pericardiocentesis was performed Because o f the deterioration of heamodynamic condition,2 patients underwent pericardial i ncision through thoracotomy and 1 patient through xiphoid approach It was confi rmed by surgical operation that coronary sinus perforation occurred in 2 patient s and left ventricular free wall perforation in 1 patient Conclusion Cardiac tamponade as a complication of RFCA was rare However,it often oc curred in old patients with left accessory pathway The common underlying mechan ism was perforation of coronary sinus The old age of the patients and the admin istration of heprin,as well as inappropriate catheter manipulation within left v entricle may contribute to the occurrence of acute cardiac tamponade