Key result
Alcohol septal ablation was followed by acute cardiac tamponade with a pericardial effusion RBC/WBC ratio of 1,957.4 compared to 728.3 in peripheral blood, suggesting altered microvascular permeability.
Case Report (n=1)
No
Alcohol-induced changes in microvascular permeability may explain cases of cardiac tamponade after alcohol septal ablation that are unrelated to mechanical trauma.
Altered permeability may explain tamponade after alcohol septal ablation without perforation; hypothesis-generating and needs prospective validation.
Various sequelae of alcohol septal ablation for hypertrophic obstructive cardiomyopathy have been reported. Of note, some cases of cardiac tamponade after alcohol septal ablation cannot be well explained. We describe the case of a 78-year-old woman with hypertrophic obstructive cardiomyopathy in whom cardiac tamponade developed one hour after alcohol septal ablation, probably unrelated to mechanical trauma. At that time, we noted a substantial difference in the red blood cell-to-white blood cell ratio between the pericardial effusion (1,957.4) and the peripheral blood (728.3). In addition to presenting the patient's case, we speculate that a possible mechanism for acute tamponade--alcohol-induced changes in microvascular permeability--is a reasonable explanation for cases of alcohol septal ablation that are complicated by otherwise-unexplainable massive pericardial effusions.
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Hsu et al. (2014) conducted a case report in Hypertrophic obstructive cardiomyopathy (n=1). Alcohol septal ablation was evaluated on Development of cardiac tamponade and pericardial effusion RBC/WBC ratio. Alcohol septal ablation was followed by acute cardiac tamponade with a pericardial effusion RBC/WBC ratio of 1,957.4 compared to 728.3 in peripheral blood, suggesting altered microvascular permeability.
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