Cardiac Tamponade During Pulmonary Vein Isolation Ablation
A 67yo male presented for pulmonary vein isolation ablation for atrial fibrillation. His past medical history consisted of two unsuccessful cardioversions and a remote history of Guillain-Barre syndrome. Approximately 5 hours into the case, the patient developed hypotension refractory to vasopressors. Echocardiography confirmed a large pericardial effusion. Heparin was reversed and urgent pericardiocentesis removed 100mL of nonclotting blood. The patient initially improved; however, after pigtail catheter insertion, 4L of blood immediately drained. Fluoroscopy revealed inadvertent right ventricle catheterization. The patient was resuscitated with massive transfusion, FEIBA, and catheter replacement. He recovered in the CICU and was discharged on POD 5.
Burandt D, Ohanian S. Cardiac tamponade during pulmonary vein isolation ablation. Abstract presented at: Anesthesiology 2019. American Society of Anesthesiology, Orlando, FL; 2019 October 19-23.