Bleeding sites and treatment strategies for cardiac tamponade by catheter ablation requiring thoracotomy: risks of catheter ablation in patients with left atrial diverticulum.
Atrial fibrillation
Cardiac tamponade
Case series
Catheter ablation
Left atrial diverticulum
Venoarterial extracorporeal membrane oxygenation
Journal
Journal of cardiothoracic surgery
ISSN: 1749-8090
Titre abrégé: J Cardiothorac Surg
Pays: England
ID NLM: 101265113
Informations de publication
Date de publication:
17 Apr 2024
17 Apr 2024
Historique:
received:
11
10
2023
accepted:
29
03
2024
medline:
19
4
2024
pubmed:
18
4
2024
entrez:
17
4
2024
Statut:
epublish
Résumé
There is insufficient information regarding the bleeding sites and surgical strategies of cardiac tamponade during catheter ablation for atrial fibrillation (AF). Of the five patients with cardiac tamponade, three required surgical intervention and two required pericardiocentesis. In the first case of three cardiac tamponades requiring surgical intervention, considering that the peripheral route was used, the catecholamines did not reach the heart, and due to unstable vital signs, venoarterial extracorporeal membrane oxygenation (VA-ECMO) was inserted. No bleeding point was identified, but a thrombus had spread around the left atrium (LA) with diverticulum. Hemostasis was achieved with adhesives placed around the LA under on-pump beating. In the second case, pericardiocentesis was performed, but the patient showed heavy bleeding and unstable vital signs. Thus, VA-ECMO was inserted. Heavy bleeding was expected, and safety was enhanced by attaching a reservoir to the VA-ECMO. The bleeding point was found between the left upper pulmonary artery and LA under cardiac arrest to obtain a good surgical view for suturing repair. In the third case, the LA diverticulum was damaged. Pericardiocentesis resulted in stable vitals, but sustained bleeding was present. A bleeding point was found at the LA diverticulum, and suture repair under on-pump beating was performed. When cardiac tamponade occured in any patient with LA diverticulum, treatment could not be completed with pericardiocentesis alone, and thoracotomy was likely to be necessary. If the bleeding point could be confirmed, suturing technique is a more reliable surgical strategy than adhesive alone that leads to pseudoaneurysm. If the bleeding point is unclear, it is important to confirm the occurrence of LA diverticulum using a preoperative CT, and if confirmed, cover it with adhesive due to a high possibility of diverticulum bleeding. The necessity of CPB should be determined based on whether these operations can be completed while maintaining vital stability.
Sections du résumé
BACKGROUND
BACKGROUND
There is insufficient information regarding the bleeding sites and surgical strategies of cardiac tamponade during catheter ablation for atrial fibrillation (AF).
CASE PRESENTATION
METHODS
Of the five patients with cardiac tamponade, three required surgical intervention and two required pericardiocentesis. In the first case of three cardiac tamponades requiring surgical intervention, considering that the peripheral route was used, the catecholamines did not reach the heart, and due to unstable vital signs, venoarterial extracorporeal membrane oxygenation (VA-ECMO) was inserted. No bleeding point was identified, but a thrombus had spread around the left atrium (LA) with diverticulum. Hemostasis was achieved with adhesives placed around the LA under on-pump beating. In the second case, pericardiocentesis was performed, but the patient showed heavy bleeding and unstable vital signs. Thus, VA-ECMO was inserted. Heavy bleeding was expected, and safety was enhanced by attaching a reservoir to the VA-ECMO. The bleeding point was found between the left upper pulmonary artery and LA under cardiac arrest to obtain a good surgical view for suturing repair. In the third case, the LA diverticulum was damaged. Pericardiocentesis resulted in stable vitals, but sustained bleeding was present. A bleeding point was found at the LA diverticulum, and suture repair under on-pump beating was performed.
CONCLUSIONS
CONCLUSIONS
When cardiac tamponade occured in any patient with LA diverticulum, treatment could not be completed with pericardiocentesis alone, and thoracotomy was likely to be necessary. If the bleeding point could be confirmed, suturing technique is a more reliable surgical strategy than adhesive alone that leads to pseudoaneurysm. If the bleeding point is unclear, it is important to confirm the occurrence of LA diverticulum using a preoperative CT, and if confirmed, cover it with adhesive due to a high possibility of diverticulum bleeding. The necessity of CPB should be determined based on whether these operations can be completed while maintaining vital stability.
Identifiants
pubmed: 38632637
doi: 10.1186/s13019-024-02710-1
pii: 10.1186/s13019-024-02710-1
pmc: PMC11022316
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
238Informations de copyright
© 2024. The Author(s).
Références
Asian Cardiovasc Thorac Ann. 2019 Nov;27(9):782-784
pubmed: 31594380
Interact Cardiovasc Thorac Surg. 2016 May;22(5):647-62
pubmed: 26819269
Circ Arrhythm Electrophysiol. 2012 Apr;5(2):345-50
pubmed: 22345391
Heart Rhythm. 2010;7(2):167-72
pubmed: 20022814
J Interv Card Electrophysiol. 2020 Aug;58(2):193-201
pubmed: 31250253
Europace. 2017 Feb 1;19(2):241-249
pubmed: 28172794
Circ Cardiovasc Imaging. 2013 Nov;6(6):1073-9
pubmed: 24014823
Heart Rhythm. 2017 Oct;14(10):e275-e444
pubmed: 28506916
Int Heart J. 2021 Nov 30;62(6):1257-1264
pubmed: 34789643
J Am Coll Cardiol. 1998 Nov;32(5):1345-50
pubmed: 9809946
Asian J Surg. 2015 Jul;38(3):174-6
pubmed: 23978429
Ann Thorac Surg. 2014 Nov;98(5):1820-1
pubmed: 25441793
J Am Coll Cardiol. 2012 Jan 10;59(2):143-9
pubmed: 22222078
Medicine (Baltimore). 2016 Sep;95(38):e4933
pubmed: 27661047
Circ Arrhythm Electrophysiol. 2014 Apr;7(2):274-80
pubmed: 24519888