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Novel approach to intraprocedural cardiac tamponade: Dual-site drainage with continuous suction

      Pericardial effusion and cardiac tamponade is an infrequent complication of invasive electrophysiologic procedures, with an estimated risk of 1%–3%.
      • Mahapatra S.
      • Bybee K.A.
      • Bunch T.J.
      • Espinosa R.E.
      • Sinak L.J.
      • McGoon M.D.
      • Hayes D.L.
      Incidence and predictors of cardiac perforation after permanent pacemaker placement.
      • Deshmukh A.
      • Patel N.J.
      • Pant S.
      • et al.
      In-hospital complications associated with catheter ablation of atrial fibrillation in the United States between 2000 and 2010: analysis of 93 801 procedures.
      • Bunch T.J.
      • Asirvatham S.J.
      • Friedman P.A.
      • Monahan K.H.
      • Munger T.M.
      • Rea R.F.
      • Sinak L.J.
      • Packer D.L.
      Outcomes after cardiac perforation during radiofrequency ablation of the atrium.
      The most common procedures with increased risk for myocardial perforation are complex ablation during endocardial mapping and/or ablation, transseptal access, and lead placement for device therapy. Although early recognition with supportive management and immediate drainage with pericardiocentesis are necessary to prevent acute hemodynamic instability, the threshold for recommending surgical correction compared to conservative management is not well established. In this article, we discuss a practical hands-on approach to tamponade, the threshold for open surgical exploration and repair, and present a case series of large-volume tamponade successfully managed with a continuous suction approach with dual-site drainage.

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