Surgical intervention for cardiac tamponade during atrial fibrillation ablation: who and when?-a single-center experience

Introduction: The critical decision between conservative therapy and surgical intervention to manage cardiac tamponade (CT) during atrial fibrillation (AF) ablation remains empirical. The aim of the study was to summarize the experience in management of CT during AF ablation to derive a proper management pathway.

Methods: All patients with CT who underwent catheter ablation for AF in our center from 2013 to 2019 were included.

Results: In total of 4887 patients, 32 (0.65%) patients occurred CT and received pericardiocentesis and immediate reversal of anticoagulation. All the CT patients were classified into three groups: rapid and uncontrollable bleeding who needed urgent surgical intervention (4/32), continuous bleeding (14/32), once pericardiocentesis, and no further bleeding (14/32). In the continuous bleeding group, the drainage volume in the first hour after pericardiocentesis was statistically related to surgical repair (p = 0.04) with a cutoff point of 970 ml (AUC 0.84, sensitivity 71.4%, specificity 100%, p = 0.04). During surgical repair, most of perforation sites were detected at superior anterior wall of left atrium close to right or left superior pulmonary vein antrum. No patient died of CT in our cohort.

Conclusions: Only a small proportion of patients with CT required surgical intervention during AF ablation. When pericardiocentesis was performed, if a drainage volume was more than 1000 ml in the first hour or bleeding was accelerated after an hour of observation, emergency surgical repair should be recommended.