TY - JOUR
T1 - Management of periprocedural and early pericardial effusions with tamponade following ablation of atrial fibrillation with uninterrupted factor Xa inhibitors
T2 - A case series
AU - Gianni, Carola
AU - Di Biase, Luigi
AU - Mohanty, Sanghamitra
AU - Trivedi, Chintan
AU - Bai, Rong
AU - Al-Ahmad, Amin
AU - Burkhardt, J. David
AU - Gallinghouse, G. Joseph
AU - Horton, Rodney P.
AU - Sanchez, Javier E.
AU - Hranitzky, Patrick M.
AU - Lakkireddy, Dhanunjaya
AU - Mansour, Moussa C.
AU - Santangeli, Pasquale
AU - Zado, Erica S.
AU - Marchlinski, Francis E.
AU - Beheiry, Salwa
AU - Hao, Steven C.
AU - Couts, Linda
AU - Gibson, Douglas
AU - Natale, Andrea
N1 - Publisher Copyright:
© 2016 Wiley Periodicals, Inc.
PY - 2016/4/1
Y1 - 2016/4/1
N2 - Management of Tamponade Following AF Ablation With FXaI Introduction Because of the absence of a dedicated reversal agent, the outcome of pericardial effusion (PE) following procedures performed with uninterrupted apixaban or rivaroxaban is unknown. We report the characteristics of PEs presenting with tamponade in patients undergoing AF ablation with uninterrupted factor Xa inhibition (FXaI) to understand their management and prognosis. Methods and Results We performed a multicenter cross-sectional survey in 10 centers across the United States. Patient data were obtained by chart review. In all patients the procedure was performed with uninterrupted FXaI. A total of 16 PEs requiring intervention were reported from 5 centers. Two patients were on apixaban 5 mg BD, the remaining on rivaroxaban 20 mg OD. Eleven PEs occurred in the periprocedural setting, and 5 PEs occurred from 1 to 28 days after the procedure. Pericardiocentesis and drainage were performed in all cases. Protamine and 4-factor prothrombin complex concentrate (4F-PCC) were given in all periprocedural cases. Two patients required surgery: in one case coagulation of the pericardial blood prevented effective drainage, and in the other bleeding was secondary to a steam pop-induced atrial tear. None of the postprocedural cases required FXaI reversal and the dose of rivaroxaban was temporarily reduced. No fatal outcomes or thromboembolic events were reported. Conclusion Pericardiocentesis and drainage with FXaI reversal proved effective in the management of acute PEs with tamponade occurring periprocedurally in patients undergoing AF ablation with uninterrupted FXaI. Early postprocedural effusions can be treated with pericardiocentesis without the need of a reversal agent.
AB - Management of Tamponade Following AF Ablation With FXaI Introduction Because of the absence of a dedicated reversal agent, the outcome of pericardial effusion (PE) following procedures performed with uninterrupted apixaban or rivaroxaban is unknown. We report the characteristics of PEs presenting with tamponade in patients undergoing AF ablation with uninterrupted factor Xa inhibition (FXaI) to understand their management and prognosis. Methods and Results We performed a multicenter cross-sectional survey in 10 centers across the United States. Patient data were obtained by chart review. In all patients the procedure was performed with uninterrupted FXaI. A total of 16 PEs requiring intervention were reported from 5 centers. Two patients were on apixaban 5 mg BD, the remaining on rivaroxaban 20 mg OD. Eleven PEs occurred in the periprocedural setting, and 5 PEs occurred from 1 to 28 days after the procedure. Pericardiocentesis and drainage were performed in all cases. Protamine and 4-factor prothrombin complex concentrate (4F-PCC) were given in all periprocedural cases. Two patients required surgery: in one case coagulation of the pericardial blood prevented effective drainage, and in the other bleeding was secondary to a steam pop-induced atrial tear. None of the postprocedural cases required FXaI reversal and the dose of rivaroxaban was temporarily reduced. No fatal outcomes or thromboembolic events were reported. Conclusion Pericardiocentesis and drainage with FXaI reversal proved effective in the management of acute PEs with tamponade occurring periprocedurally in patients undergoing AF ablation with uninterrupted FXaI. Early postprocedural effusions can be treated with pericardiocentesis without the need of a reversal agent.
KW - 4-factor prothrombin complex concentrate
KW - apixaban
KW - atrial fibrillation ablation
KW - factor Xa inhibitors
KW - pericardial tamponade
KW - rivaroxaban
KW - uninterrupted anticoagulation
UR - http://www.scopus.com/inward/record.url?scp=84975687822&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84975687822&partnerID=8YFLogxK
U2 - 10.1111/jce.12918
DO - 10.1111/jce.12918
M3 - Article
C2 - 26756289
AN - SCOPUS:84975687822
SN - 1045-3873
VL - 27
SP - 399
EP - 403
JO - Journal of cardiovascular electrophysiology
JF - Journal of cardiovascular electrophysiology
IS - 4
ER -