Abstract 13682: Incidence and Clinical Characteristics of Postcardiac Injury Syndrome Complicating Cardiac Perforation Caused by Radiofrequency Catheter Ablation for Cardiac Arrhythmias
Background Postcardiac injury syndrome (PCIS) is a complication of a variety of cardiac injuries, of which minor perforation of the heart with a cardiac catheter is a rare, under-recognized etiology. Under this situation, PCIS is always under-diagnosed because pericarditis/pericardial effusion may attribute to cardiac perforation and can not be used as diagnostic criteria of PCIS. Unexplained pleural effusion, fever, and chest pain, become the most important clinical features. We reported a series of patients with PCIS secondary to cardiac perforation during catheter ablation procedures.
Methods and Results Out of 1728 procedures performed over 6 years, 21 patients (1.2%) were complicated by echo-defined cardiac perforation. Among them, 6 patients (6/21, 28.6%) were diagnosed with PCIS secondary to cardiac perforation because they also developed pleural effusion (6 pts, 100%) and fever (4 pts, 66.7%) in addition to pericardial effusion/tamponade. Four patients with PCIS (4/6, 66.7%) and four patients without PCIS (4/15, 26.7%) underwent pericardial drainage but the drainage volume during the first 24 hours was not significantly different (441.3±343.9 ml vs 182.5±151.3 ml, P=0.24). In PCIS patients, pleural effusion was detected from 3 hours to 6 days (median: 2 days) after ablation procedure, predominantly bilateral (66.7%) or left-sided if unilateral. PCIS patients were older (64.8±7.3 vs 45.9±14.8 yrs, P=0.0078) and more likely accompanied by hypertension (66.7% vs 6.7%, P=0.01) comparing to those without PCIS. Three PCIS patients were prescribed steroid or NSAIDs while symptoms and signs disappeared spontaneously in the other 3 cases. These 6 PCIS patients had a prolonged hospital stay (34.2±15.8 days) mainly because a delayed diagnose of PCIS and unnecessary screening for other diseases.
Conclusion More than one forth of patients with cardiac perforation during catheter ablation may develop PCIS which can be masked by pericardial effusion/tamponade. Unlike PCIS secondary to other cardiac injuries, pleural effusion or fever may occur as early as 3 hours after the ablation procedure. These clinical features following cardiac perforation indicate the possibility of PCIS. Steroid or NSAID can be used in patients without spontaneous recovery.
- © 2012 by American Heart Association, Inc.