Key result
Gas analysis links ~47% of catheter ablation pericardial effusions to right heart venous perforation.
Why the study?
Pericardial effusion is a major complication during catheter ablation, but literature identifying the responsible perforation site has been limited.
Observational (n=18)
No
Gas analysis of pericardial effusions during catheter ablation demonstrates that nearly half originate from the venous system, highlighting the underrecognized risk of right-sided perforation from diagnostic catheters even during left-sided procedures.
Answers are grounded in this paper and cite their sources.
May heighten vigilance for right heart catheter perforation during ablation; extends perforation source data but leaves open need for prospective confirmation.
BACKGROUND: The incidence of pericardial effusion (PE) during radiofrequency catheter ablation (CA) for atrial fibrillation is approximately 1%. PE is a major complication during CA, but there has been limited literature about the perforation site responsible. OBJECTIVE: This study aimed to retrospectively investigate the characteristics of the procedure and the patients in whom PE developed during CA. METHODS: Of 1363 consecutive patients who underwent catheter ablation from January 2015 to June 2019 in Kyorin University Hospital, we reviewed patients who developed PE during CA. RESULTS: PE during CA occurred in 18 (1.32%) patients (median age, 71 [interquartile range (IQR) 65-77] years, 7 women). The median body mass index was 24 (IQR 20-27). Target arrhythmias for CA of patients with PE include atrial fibrillation (AF) (n = 13, 72%), premature ventricular contraction (n = 2, 11%), ventricular tachycardia (n = 1, 6%), atrial flutter (n = 1, 6%), and orthodromic reciprocating tachycardia (n = 1, 6%). Seventeen patients required pericardiocentesis, resulting in 300 (IQR 192.5-475) mL of drainage. Two patients required emergency surgical repair, and 1 died from aortic dissection. Based on the gas analysis, the drained blood was of venous origin in 47% of the total events and 54% of AF ablation. CONCLUSION: PE caused by a diagnostic catheter in the right heart is not uncommon, even in AF ablation.
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Katsume et al. (2020) conducted an observational in Pericardial effusion complicating radiofrequency catheter ablation (n=18). Diagnostic catheter use during radiofrequency catheter ablation was evaluated on Venous origin of the drained pericardial effusion blood based on gas analysis. Gas analysis revealed that 47% of pericardial effusions during catheter ablation were of venous origin, suggesting that diagnostic catheters in the right heart are a frequent cause of perforation.
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