Author + information
- Received April 29, 2016
- Revision received September 26, 2016
- Accepted September 30, 2016
- Published online April 17, 2017.
- Michala E.F. Pedersen, MD∗ (, )
- Milena Leo, MD,
- Manish Kalla, MD,
- Aniel Malhotra, MD,
- Matthew Stone, MD,
- Kelvin Wong, MD,
- Kim Rajappan, MD,
- Matthew Ginks, MD,
- Timothy R. Betts, MD and
- Yaver Bashir, MD
- Oxford University Hospitals NHS Foundation Trust, Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom
- ↵∗Address for correspondence:
Dr. Michala E.F. Pedersen, Department of Cardiology, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom.
Objectives This study reports on the safety of early removal of pericardial drains after cardiac tamponade complicating atrial fibrillation catheter ablation (AFCA) procedures, the need for repeat pericardiocentesis, major adverse outcomes, as well as length of stay, and the need for opiate analgesia.
Background Tamponade from AFCA is traditionally managed by pericardiocentesis with delayed removal of the drain (typically 12 to 24 h later) in case of re-bleeding. A drain in situ often causes severe pain but ongoing blood loss is rare. Our institution adopted the practice of early removal of drains before leaving the laboratory if bleeding has stopped.
Methods The authors performed a retrospective descriptive analysis of 43 cases of tamponade complicating AFCA from 2006 to 2015, comparing patients in whom the drain was removed early (group early removal [ER]; n = 25) versus traditional delayed removal (group delayed removal [DR]; n = 18).
Results The groups were similar with respect to clinical/demographic characteristics, proportions of first-time versus re-do and pulmonary vein isolation versus pulmonary vein isolation + additional ablation. There were no deaths. No ER patients required drain re-insertion before discharge. The length of stay was shorter in the ER group (3 days; range 1 to 9 days) than in the DR group (4 days; range 2 to 60 days). The requirement for opiate analgesia was less in the ER group (8%) than in the DR group (72%).
Conclusions Early removal of pericardial drains after tamponade complicating AFCA procedures appears to be safe and effective, with re-insertion not required in this cohort. The traditional practice of leaving drains in situ for 12 to 24 h may result in more patient discomfort and longer hospitalization.
Dr. Betts is supported by the Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, United Kingdom. Dr. Leo has received a research fellowship from St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received April 29, 2016.
- Revision received September 26, 2016.
- Accepted September 30, 2016.
- 2017 American College of Cardiology Foundation