Abstract 16442: Unusually High Incidence of Dressler’s Syndrome After Hybrid Ablation for Atrial Fibrillation
Introduction: Dressler’s syndrome (DS), often difficult to diagnose, occurs after open-heart surgery or myocardial infarction but rarely after catheter ablation (abl). With the emergence of minimally invasive hybrid abl (HA) strategies for atrial fibrillation (AF), combining more extensive epicardial abl with standard pulmonary vein isolation (PVI), we became concerned regarding an increased incidence of DS. The purpose of this report is to review incidence, risk factors and treatment for DS after HA.
Methods: HA used videoscopic-guided epicardial abl of the posterior left atrium (LA) (“Convergent” procedure) with radiofrequency (RF) followed by endocardial PVI with RF or cryoballoon in the same procedure. Pts received NSAID during hospital stay. All pts had drug-refractory symptomatic long-standing persistent AF and/or failed prior abls.
Results: Thirty-seven pts (age 62±8yrs, 71% male) were followed after HA and 6 developed DS (16%) at 28±21 days post HA. This incidence was much greater than the 0.2% in a control group of the last 1000 pts with standard PVI (p<0.0001). Presenting symptoms included pleuritic chest pain (4 pts), cough (4 pts) and dyspnea (2 pts). Five pts patients had pericardial effusion on echo or CT (large in 3), and 2 had pleural effusions. DS resolution timing varied, ranging from 1 to 12 weeks. All pts received oral steroids, and selected pts needed treatment with NSAID (1 pt), colchicine (1 pt), diuretic (1 pt) and inhaled steroid (1 pt). Only 1 pt required pericardiocentesis. Inflammatory markers (CBC, ESR) in the early post-abl period were not predictive of development of DS, but prevalence of blood type O+ was significantly higher in pts with DS (67%) compared to those without (20%, p=0.02). Pts with DS had the same response to HA as patients without, with an overall success rate of 90% at 6 months.
Conclusions: DS was a much more common complication after HA compared to standard abl for AF. The extensive abl of the posterior LA may cause significant myolysis enhancing the possibility of an immune response. More studies will be needed to identify risk factors that may allow early intervention to prevent DS, which adds substantial morbidity and cost to this otherwise well tolerated and highly successful treatment for difficult to treat pts with AF.
Author Disclosures: T.C. Sichrovsky: None. D.F. Rivera: None. S. Mittal: Consultant/Advisory Board; Modest; St Jude Medical. A. Arshad: None. M. Preminger: None. D. Musat: None. J.S. Steinberg: None.
- © 2014 by American Heart Association, Inc.