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Pericardial effusion following drain removal after percutaneous epicardial access for an electrophysiology procedure
Ammar M Killu1, Siu-Hin Wan, Thomas M Munger
1Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota; Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Insights
Postoperative pericardial effusion after epicardial sheath removal is infrequent, affecting 4.9% of patients. Younger patients and those undergoing inferior access may have a higher risk.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Procedures
Background:
- Pericardial effusion is a known complication of cardiac procedures.
- Percutaneous epicardial access (EpiAcc) is increasingly used in electrophysiology ablation.
Purpose of the Study:
- To determine the frequency of pericardial effusion after epicardial sheath removal.
- To identify predictors of pericardial effusion following percutaneous epicardial access.
Main Methods:
- Retrospective analysis of electronic medical records.
- Inclusion of patients undergoing planned EpiAcc for electrophysiology ablation from 2004-2013.
- Analysis of patient demographics, procedural details, and outcomes.
Main Results:
- 4.9% of 144 patients developed postoperative pericardial effusion requiring repeat access.
- Inferior access approach (P=0.06) and higher preprocedure ejection fraction (P=0.03) were associated with effusion.
- Patients with effusion tended to be younger (P=0.08).
Conclusions:
- Postoperative pericardial effusion after epicardial procedures is relatively infrequent.
- Close observation is necessary as effusions can present early or delayed.
- No procedural-related deaths occurred.
Objectives:
To determine the frequency and predictors of pericardial effusion following epicardial sheath removal.
Background:
Pericardial effusion can occur following cardiac surgical or interventional procedures including percutaneous epicardial access (EpiAcc), which is increasingly used as part of electrophysiology ablation procedures.
Methods:
A retrospective analysis of the Mayo Clinic comprehensive electronic medical record was performed from all patients who underwent planned EpiAcc as part of an electrophysiology ablation procedure between January 1, 2004 and June 30, 2013.
Results:
Of 144 patients (mean age 51.3 ± 15.5 years, 68% male) who underwent planned EpiAcc as part of an electrophysiology ablation (95.8% pericardial access success rate), seven (4.9%) developed a postoperative pericardial effusion requiring repeat EpiAcc. Inferior access was utilized in 74 (51.4%) patients. Patients with pericardial effusion tended to be younger (41.1 years vs 51.8 years, P = 0.08) and were more likely to have undergone inferior approach access (85.7% vs 49.6%, P = 0.06) than those who did not develop postoperative pericardial effusion. Seventy-one percent of patients with postoperative pericardial effusion versus 32.1% of patients without postoperative pericardial effusion had a preprocedure ejection fraction ≥55% (P = 0.03). There were no procedural-related deaths, and no difference in mortality between groups.
Conclusions:
Postoperative pericardial effusion requiring repeat access/drainage was relatively infrequent, occurring in 4.9% of patients shortly after epicardial procedures. While the majority occur early and therefore require close observation, some patients may present in a delayed manner.
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