A serious complication of high-power short-duration radiofrequency atrial fibrillation ablation associated with genetic hypodysfibrinogenemia

Cardiac tamponade is a rare and potentially fatal outcome in patients who undergo atrial fibrillation (AF) ablation1. In the US about 2.7 million are known to have AF, and of those approximately 0.8% undergo catheter ablation. Cardiac perforation with radiofrequency ablation (RFA) likely occurs through two mechanisms: mechanical complications with the sheath and catheter or steam pops with RFA. Surgery to repair the cardiac perforation is more common after a steam pop2. High power short duration (HPSD) RFA is now commonly used in AF ablation due to shortened procedure times with no decreased long-term efficacy or increased complications compared to low power long duration ablation3,4,5,6 .This case highlights the occurrence of cardiac tamponade during AF ablation using HPSD RFA in a patient with a rare bleeding diathesis due to hypodysfibrinogenemia.