What is the clinical evidence from this study?

Study design: Review. Population: Patients undergoing invasive cardiac procedures. Intervention: Invasive cardiac procedures (AF ablation, PCI, PHRD, LAA closure, TAVI, Mitra-Clip). Primary outcome: Rate of iatrogenic pericardial tamponade.

January 1, 2019Open Access

Pericardial tamponade as a complication of invasive cardiac procedures: a review of the literature

MAMaria AdamczykRudolfinerhaus Hospital JWJarosław WasilewskiMedical University of Silesia JNJacek NiedzielaAndrzej Frycz Modrzewski Krakow University

Key Result

The overall rate of iatrogenic pericardial tamponade after invasive cardiac procedures varies from 0.089% to 4.8%, with the highest rates observed after left atrial appendage closure, transcatheter aortic valve implantation, and atrial fibrillation ablation.

Structured PICO

What is the rate of pericardial tamponade as a complication of various invasive cardiac procedures?

Population

A literature review of clinical studies published up to December 2018 assessing the rate of iatrogenic pericardial tamponade in adults undergoing various invasive cardiac procedures.

Intervention

Invasive cardiac procedures (atrial fibrillation ablation, percutaneous coronary intervention, permanent heart rhythm devices, left atrial appendage closure, transcatheter aortic valve implantation, and percutaneous mitral valve repair)

Outcome

Rate of iatrogenic pericardial tamponadesafety

Pericardial tamponade is a rare but potentially fatal complication of invasive cardiac procedures, with incidence ranging from 0.089% to 4.8% depending on the procedure type, particularly those involving transseptal puncture or anticoagulation.

Limitations

Many of the mentioned studies only determine predictors of iatrogenic PT or the endpoint of those studies was only the rate of PT, and a follow-up was not performed.

Abstract

Cardiac tamponade (CT) is a rare but often life-threatening complication after invasive cardiac procedures. Some procedures favor CT. Furthermore, the incidence depends on patients' comorbidities, sex and age and operators' skills. In this paper we review studies and meta-analyses concerning the rate of iatrogenic CT. We define the risk factors of CT and show concise characteristics for each invasive cardiac procedure separately. According to our analysis CT occurs especially after procedures requiring transseptal puncture or perioperative anticoagulation. The overall rate of CT after such procedures varies among published studies from 0.089% to 4.8%. For this purpose we searched the PubMed database for clinical studies published up to December 2018. We included only those studies in which a defined minimum of procedures were performed (1000 for atrial fibrillation ablation, 6000 for percutaneous coronary intervention, 900 for permanent heart rhythm devices, 90 for left atrial appendage closure, 300 for transcatheter aortic valve implantation and percutaneous mitral valve repair with the Mitra-Clip system). The search was structured around the key words and variants of these terms. In addition, secondary source documents were identified by manual review of reference lists, review articles and guidelines. The search was limited to humans and adults (18+ years).

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