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Internal transcardiac pericardiocentesis for acute tamponade

  • John D Fisher
    Correspondence
    Dr. Fisher’s address is: Montefiore Medical Center, Cardiology/Arrhythmia Offices N2, 111 East 210th Street, Bronx, New York 10467
    Affiliations
    The Department of Medicine, Cardiovascular Division, Arrhythmia Service, Montefiore Medical Center, and the Albert Einstein College of Medicine, Bronx, New York, USA
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  • Soo G Kim
    Affiliations
    The Department of Medicine, Cardiovascular Division, Arrhythmia Service, Montefiore Medical Center, and the Albert Einstein College of Medicine, Bronx, New York, USA
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  • Kevin J Ferrick
    Affiliations
    The Department of Medicine, Cardiovascular Division, Arrhythmia Service, Montefiore Medical Center, and the Albert Einstein College of Medicine, Bronx, New York, USA
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  • Jay N Gross
    Affiliations
    The Department of Medicine, Cardiovascular Division, Arrhythmia Service, Montefiore Medical Center, and the Albert Einstein College of Medicine, Bronx, New York, USA
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  • Mark H Goldberger
    Affiliations
    The Department of Medicine, Cardiovascular Division, Arrhythmia Service, Montefiore Medical Center, and the Albert Einstein College of Medicine, Bronx, New York, USA
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  • Michele Nanna
    Affiliations
    The Department of Medicine, Cardiovascular Division, Arrhythmia Service, Montefiore Medical Center, and the Albert Einstein College of Medicine, Bronx, New York, USA
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      Radiofrequency catheter ablation of accessory pathways related to the Wolff-Parkinson-White (WPW) syndrome has become the treatment of choice for symptomatic patients. The retrograde and the transseptal approaches are comparable and standard for addressing left-sided pathways.
      • Lesh M.D.
      • Van Hare G.F.
      • Scheinman M.M.
      • Ports T.A.
      • Epstein L.A.
      Comparison of the retrograde and transseptal methods for ablation of left freewall accessory pathways.
      ,
      • Deshpande S.S.
      • Bremner S.
      • Sra J.S.
      • Dhala A.A.
      • Blanck Z.
      • Bajwa T.K.
      • al-Bitar I.
      • Gal R.
      • Sarnoski J.S.
      • Akhtar M.
      Ablation of left free-wall accessory pathways using radiofrequency energy at the atrial insertion site transseptal versus transaortic approach.
      Cardiac tamponade due to perforation of the left atrial free wall is among the complications of the transseptal approach, with
      • Hahn K.
      • Gal R.
      • Sarnoski J.
      • Kubota J.
      • Schmidt D.H.
      • Bajwa T.K.
      Transesophageal echocardiographically guided atrial transseptal catheterization in patients with normal-sized atria incidence of complications.
      or without
      • Roelke M.
      • Smith A.J.
      • Palacios I.F.
      The technique and safety of transseptal left heart catheterization the Massachusetts General Hospital experience with 1,279 procedures.
      ,
      • Swartz J.F.
      • Tracy C.M.
      • Fletcher R.D.
      Radiofrequency endocardial catheter ablation of accessory atrioventricular pathway atrial insertion sites.
      ,

      Clugston R, Lau FY, Ruiz C. Transseptal catheterization update 1992. Cathet Cardiovasc Diagn 1992;26:266–274.

      echocardiographic guidance. This complication requires immediate drainage by needle aspiration
      • Tsang T.S.
      • Freeman W.K.
      • Barnes M.E.
      • Reeder G.S.
      • Packer D.L.
      • Seward J.B.
      Rescue echocardiographically guided pericardiocentesis for cardiac perforation complicating catheter-based procedures. The Mayo Clinic experience.
      ,
      • Ball J.B.
      • Morrison W.L.
      Cardiac tamponade.
      ,
      • Chong H.H.
      • Plotnick G.D.
      Pericardial effusion and tamponade evaluation, imaging modalities, and management.
      ,
      • Friedrich S.P.
      • Berman A.D.
      • Baim D.S.
      • Diver D.J.
      Myocardial perforation in the cardiac catheterization laboratory incidence, presentation, diagnosis, and management.
      or surgery.
      • Susini G.
      • Pepi M.
      • Sisillo E.
      • Bortone F.
      • Sallvi L.
      • Barbier P.
      • Fiorentin C.
      Percutaneous pericardiocentesis versus subxiphoid pericardiotomy in cardiac tamponade due to postoperative pericardial effusion.
      ,
      • Nocero Jr, M.A.
      These are often used with placement of an intrapericardial sheath or catheter for continuing drainage.
      • Ball J.B.
      • Morrison W.L.
      Cardiac tamponade.
      ,
      • Susini G.
      • Pepi M.
      • Sisillo E.
      • Bortone F.
      • Sallvi L.
      • Barbier P.
      • Fiorentin C.
      Percutaneous pericardiocentesis versus subxiphoid pericardiotomy in cardiac tamponade due to postoperative pericardial effusion.
      These interventions are effective, but psychologically unpalatable to patient and physician alike. This article reports an alternative internal drainage method that is psychologically atraumatic to the patient, and has been followed by successful ablation within the next 24 hours with an overall satisfactory outcome.
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      References

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        • Ports T.A.
        • Epstein L.A.
        Comparison of the retrograde and transseptal methods for ablation of left freewall accessory pathways.
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        • Deshpande S.S.
        • Bremner S.
        • Sra J.S.
        • Dhala A.A.
        • Blanck Z.
        • Bajwa T.K.
        • al-Bitar I.
        • Gal R.
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        Ablation of left free-wall accessory pathways using radiofrequency energy at the atrial insertion site.
        J Cardiovasc Electrophysiol. 1994; 5: 219-231
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        • Gal R.
        • Sarnoski J.
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        Transesophageal echocardiographically guided atrial transseptal catheterization in patients with normal-sized atria.
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        The technique and safety of transseptal left heart catheterization.
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        • Tracy C.M.
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        Radiofrequency endocardial catheter ablation of accessory atrioventricular pathway atrial insertion sites.
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        • Tsang T.S.
        • Freeman W.K.
        • Barnes M.E.
        • Reeder G.S.
        • Packer D.L.
        • Seward J.B.
        Rescue echocardiographically guided pericardiocentesis for cardiac perforation complicating catheter-based procedures. The Mayo Clinic experience.
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