Surgical Repair of Cardiac Perforation during Catheter Ablation: Two Cases Reports

Severe complications of catheter ablation include cardiac tamponade, sometimes requiring surgical repair. The causes of cardiac perforation during catheter procedures vary among studies. Emergent surgical repair may be life-saving if cardiac tamponade is not relieved by pericardiocentesis or if extensive damage is suspected. Case presentation: In Case 1, a 97-year-old female patient with symptomatic rapid atrial fibrillation who underwent catheter ablation was transferred with stable vital signs. After arrival at our hospital, the patient's vital signs deteriorated, and emergency surgery was performed. A 7-Fr catheter was identified intraoperatively at the roof of left atrium, and the perforation site was surgically closed. The patient was transferred to a referral hospital on postoperative day 5. In Case 2, an 82-year-old female patient with symptomatic paroxysmal atrial fibrillation who had undergone catheter ablation 1 month earlier underwent a repeat catheterization procedure. Steam explosions during the catheter procedure caused myocardial damage, followed by cardiac perforation and tamponade. The patient was transferred under veno-arterial extracorporeal membrane oxygenation. Emergency surgical repair was performed, and perforation with active bleeding was identified in the right atrium. The perforation site was surgically closed and the patient was transferred to the referral hospital on postoperative day 24. Conclusions: In patients with cardiac tamponade caused by catheter ablation, surgical intervention may be effective if shock is refractory to pericardiocentesis or mechanical support is required for hemodynamic stabilization.