Management of Periprocedural and Early Pericardial Effusions With Tamponade Following Ablation of Atrial Fibrillation With Uninterrupted Factor Xa Inhibitors: A Case Series

Carola Gianni, Luigi Di Biase, Sanghamitra Mohanty, Chintan Trivedi, Rong Bai, Amin Al-Ahmad, J. David Burkhardt, G. Joseph Gallinghouse, Rodney P. Horton, Javier E. Sanchez, Patrick M. Hranitzky, Dhanunjaya Lakkireddy, Moussa C. Mansour, Pasquale Santangeli, Erica S. Zado, Francis E. Marchlinski, Salwa Beheiry, Steven C. Hao, Linda Couts, Douglas GibsonAndrea Natale

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
JournalJournal of Cardiovascular Electrophysiology
DOIs
StateAccepted/In press - 2016

Fingerprint

Factor Xa
Pericardial Effusion
Atrial Fibrillation
Pericardiocentesis
Drainage
Protamines
Fatal Outcome
Steam
Blood Coagulation
Tears
Factor Xa Inhibitors
Cross-Sectional Studies
Hemorrhage
Rivaroxaban

Keywords

  • 4-factor prothrombin complex concentrate
  • Apixaban
  • Atrial fibrillation ablation
  • Factor Xa inhibitors
  • Pericardial tamponade
  • Rivaroxaban
  • Uninterrupted anticoagulation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Management of Periprocedural and Early Pericardial Effusions With Tamponade Following Ablation of Atrial Fibrillation With Uninterrupted Factor Xa Inhibitors : A Case Series. / Gianni, Carola; Di Biase, Luigi; Mohanty, Sanghamitra; Trivedi, Chintan; Bai, Rong; Al-Ahmad, Amin; Burkhardt, J. David; Gallinghouse, G. Joseph; Horton, Rodney P.; Sanchez, Javier E.; Hranitzky, Patrick M.; Lakkireddy, Dhanunjaya; Mansour, Moussa C.; Santangeli, Pasquale; Zado, Erica S.; Marchlinski, Francis E.; Beheiry, Salwa; Hao, Steven C.; Couts, Linda; Gibson, Douglas; Natale, Andrea.

In: Journal of Cardiovascular Electrophysiology, 2016.

Research output: Contribution to journalArticle

Gianni, C, Di Biase, L, Mohanty, S, Trivedi, C, Bai, R, Al-Ahmad, A, Burkhardt, JD, Gallinghouse, GJ, Horton, RP, Sanchez, JE, Hranitzky, PM, Lakkireddy, D, Mansour, MC, Santangeli, P, Zado, ES, Marchlinski, FE, Beheiry, S, Hao, SC, Couts, L, Gibson, D & Natale, A 2016, 'Management of Periprocedural and Early Pericardial Effusions With Tamponade Following Ablation of Atrial Fibrillation With Uninterrupted Factor Xa Inhibitors: A Case Series', Journal of Cardiovascular Electrophysiology. https://doi.org/10.1111/jce.12918
Gianni, Carola ; Di Biase, Luigi ; Mohanty, Sanghamitra ; Trivedi, Chintan ; Bai, Rong ; Al-Ahmad, Amin ; Burkhardt, J. David ; Gallinghouse, G. Joseph ; Horton, Rodney P. ; Sanchez, Javier E. ; Hranitzky, Patrick M. ; Lakkireddy, Dhanunjaya ; Mansour, Moussa C. ; Santangeli, Pasquale ; Zado, Erica S. ; Marchlinski, Francis E. ; Beheiry, Salwa ; Hao, Steven C. ; Couts, Linda ; Gibson, Douglas ; Natale, Andrea. / Management of Periprocedural and Early Pericardial Effusions With Tamponade Following Ablation of Atrial Fibrillation With Uninterrupted Factor Xa Inhibitors : A Case Series. In: Journal of Cardiovascular Electrophysiology. 2016.
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abstract = "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.",
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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

PY - 2016

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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.

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KW - Factor Xa inhibitors

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KW - Rivaroxaban

KW - Uninterrupted anticoagulation

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