Introduction Pericardiocentesis is a life-saving procedure to remove excess fluid from pericardium in cardiac tamponade, in some circumstances it may be used for diagnostic purposes. Due to invasive nature, it carries potential risks although the use of imaging guidance has reduced risk significantly. We aim to provide an up-to-date analysis of pericardiocentesis complications occurring at a high-volume tertiary cardiac referral centre in UK. Method This was a single centre retrospective study of patients who underwent pericardiocentesis between February 2010 and June 2023 at Barts Heart Centre, London. Data was collected from electronic patient record and entered into database. Data extracted included demographics, procedural approach, imaging mode, size of effusion, urgency of procedure, aetiology of pericardium effusion, outcomes and complications of procedure. Result 329 patients underwent pericardiocentesis with median age of 57 yrs. Most of the procedures(90.5%) were performed as urgent or emergency for large effusions with evidence of cardiac tamponade or impending tamponade. Majority were drained using subcostal approach(80.8%). All procedures were carried out under transthoracic echocardiogram or fluoroscopic guidance. Malignancy accounted for the cause in half of the study cohort(50.4%). In non-malignant group, idiopathic(10.6%) was most common, followed by parapneumonic aetiology(6.1%). Complications occurred in 19/329 cases(5.8%), with minor complication rate of 3.0%(see table 1) and major of 2.7%(see table 2). Right cardiac chamber puncture occurred in 5/329 cases(1.5%), majority had no significant sequelae. There was one death directly attributable to the procedure as a result of right cardiac chamber puncture. There was one case of injury to adjacent organ, in this case hepatic injury resulting in a liver hematoma. Pericardial decompression occurred in 2/330 cases representing a rate of 1% in patient cohort. Conclusion Pericardiocentesis performed in an expert centre under imaging guidance is safe with low complication rate. In our unselected large patient cohort, the rate of major and minor complications was in line with expected complication rate from the literature. Complications whilst rare, can be significant in their nature when they occur, centres should have the necessary expertise and equipment readily available to manage.
Maung et al. (2025) studied this question.