A 63-year-old male developed a pulmonary embolism and severe pericardial effusion requiring a subxiphoid pericardial window following atrial fibrillation ablation despite rivaroxaban therapy.
Case Report (n=1)
This case highlights the potential for severe post-ablation complications, including pulmonary embolism despite anticoagulation and pericarditis progressing to significant pericardial effusion requiring surgical drainage.
Abstract Introduction Catheter ablation is a key treatment for atrial fibrillation (AF), improving rhythm control and symptom relief. Despite advances in technique and technology, post-procedural complications like pulmonary embolism (PE), pericarditis, and pericardial effusion remain concerns. PE, though rare, can be worsened by procedural factors, anticoagulation, and patient risk factors. Pericarditis, caused by inflammation or thermal injury to the pericardium, may lead to pericardial effusion and, in severe cases, cardiac tamponade. Early recognition of these complications is essential to prevent hemodynamic issues and improve patient outcomes. Case Presentation A 63-year-old male with AF post-ablation, hypertension, hyperlipidemia, and mild cardiomyopathy presented with sharp, constant chest pain radiating to the back, relieved by morphine and nitroglycerin. He reported dyspnea, especially when lying flat, and abdominal bloating without nausea or vomiting. He was compliant with rivaroxaban and had recently traveled to Denver, with no hypercoagulable history or recent procedures besides ablation. ECG initially showed sinus rhythm with frequent PVCs; repeat ECG revealed inferior ST elevations and ST depression in aVR. Troponin was elevated. Imaging showed pulmonary edema, bilateral pleural effusions, and a small PE despite rivaroxaban. He was started on a heparin drip pending hematology input. His symptoms were attributed to post-ablation pericarditis, and colchicine was initiated. Hematology switched anticoagulation to dabigatran, and electrophysiology advised continuing flecainide for six weeks. He was discharged with close follow-up. Ten days later, he was readmitted with worsening dyspnea and orthopnea. Echocardiogram revealed a moderate-to-severe pericardial effusion. CT surgery performed a subxiphoid pericardial window. Drain output decreased daily; by postoperative day five, it was removed, and anticoagulation with colchicine was resumed without complication. Discussion Pulmonary embolism after atrial fibrillation ablation is rare but challenging to diagnose, especially in anticoagulated patients. This case demonstrates PE despite rivaroxaban use, suggesting a transient hypercoagulable state or incomplete anticoagulation, highlighting the need for close monitoring and tailored therapy. Pericarditis is a common post-ablation inflammatory response that can progress to significant pericardial effusion, as seen in this patient. Serial echocardiographic assessments are crucial for early detection and management. Delayed pericardial effusion poses diagnostic and therapeutic challenges. While minor cases resolve conservatively, larger effusions may require drainage. The need for surgical intervention in this case underscores the potential severity of post-ablation complications. Given the lack of clear guidelines, this case highlights the importance of individualized monitoring, anticoagulation strategies, and further research to optimize management and patient outcomes. This abstract is funded by: None
Kaur et al. (Fri,) conducted a case report in Post-ablation complications (pulmonary embolism, pericarditis, pericardial effusion) (n=1). Subxiphoid pericardial window and medical management was evaluated. A 63-year-old male developed a pulmonary embolism and severe pericardial effusion requiring a subxiphoid pericardial window following atrial fibrillation ablation despite rivaroxaban therapy.