Abstract 12498: Management and Outcomes of Cardiac Tamponade during Atrial Fibrillation Ablation in the Presence of Therapeutic Anticoagulation with Warfarin
Background: Cardiac tamponade (CT) is an important complication associated with catheter ablation of atrial fibrillation (AF). The incidence of CT has been reported to be unchanged when ablation is performed during therapeutic anticoagulation with warfarin. We sought to compare outcomes of CT during AF ablation between patients who were and were not therapeutically anticoagulated with warfarin.
Methods: We retrospectively studied 40 consecutive patients who developed CT during catheter ablation for AF at 3 institutions (University of Michigan, Indiana University, and Brigham and Women's Hospital). We compared 2 groups: 17 patients who had an INR ≥ 2 at the time of the procedure and a control group of 23 patients with an INR < 2 (mean INR 2.4±0.4 vs. 1.4±0.3, p<0.001). Heparin was given during the procedure at a mean dose of 7964±2051 vs. 11422±4807 units (p=0.005) and the highest ACT was 309±53 vs. 317±63 sec (p=0.7) in the INR ≥ 2 and INR < 2 groups, respectively.
Results: INR was normalized by Factor VIIa in 3 (18%) vs. 1 (4%) patient (p=0.3) and by fresh frozen plasma in 3 (18%) vs. 3 (13%) patients (p=0.5) in the INR ≥ 2 and INR < 2 groups, respectively. Protamine was infused to reverse heparin at a mean dose of 49±21 vs. 44±30 mg (p=0.524) in the INR ≥ 2 and INR < 2 groups, respectively. During resuscitation, packed red blood cells were transfused in 2 (12%) vs. 3 (13%) patients (p=1.00) and pressors given in 11 (65%) vs. 18 (78%) patients (p=0.5) in the INR ≥ 2 and INR < 2 groups, respectively. There were no significant differences in initial mean blood volume drained (409±157 vs. 523±349 ml, p=0.2) or mean duration of the pericardial drain (1.0±1.2 vs. 1.3±0.9 days, p = 0.4) between the 2 groups. Mean length of hospital stay was 2.8±1.8 vs. 5±5.3 days (p=0.1) in the INR ≥ 2 and INR < 2 groups, respectively. Excluding an outlier patient with a 28 day stay in the control group due to renal and hepatic failure, mean length of stay was significantly shorter (2.8±1.8 vs. 3.9±1.7 days, p <0.05) in the INR ≥ 2 group. Surgical intervention was not required in any patient and all patients survived to hospital discharge.
Conclusions: The severity and outcomes of cardiac tamponade are not worsened in the presence of therapeutic anticoagulation with warfarin in patients undergoing catheter ablation of AF.
- © 2010 by American Heart Association, Inc.