Acute cardiac tamponade during atrial flutter ablation: improved hemodynamics after positive pressure ventilation: a case report

• Published in: Journal of medical case reports 2023-12, Vol.17 (1), p.523-523, Article 523
• Main Authors: Royster, Roger L, Coleman, Scott R, Goenaga-Díaz, Eduardo J, Richardson, Karl M, Whalen, S Patrick
• Format: Article
• Language: English
• Subjects: Ablation; Ablation (Surgery); Aged, 80 and over; Atrial flutter; Atrial Flutter - complications; Atrial Flutter - surgery; Atrial flutter ablation; Blood pressure; Cardiac patients; Cardiac resuscitation; Cardiac tamponade; Cardiac Tamponade - etiology; Cardiac Tamponade - surgery; Cardiopulmonary resuscitation; Case Report; Case reports; Catecholamines; Catheter Ablation - adverse effects; Catheter Ablation - methods; Catheters; CPR; Drug delivery systems; Drugs; Epinephrine; General anesthesia; Heart; Hemodynamics; Hemodynamics - physiology; Humans; Hypotension; Intensive care; Intubation; Lungs; Male; Mode of ventilation; Patient-centered care; Patients; Pericardium; Positive-Pressure Respiration - adverse effects; Prospective Studies; Respiration; Ultrasonic imaging; Vehicles; Ventilation; Ventilators
• ISSN: 1752-1947; 1752-1947
• DOI: 10.1186/s13256-023-04268-3

Acute cardiac tamponade is a rare event during any type of interventional or surgical procedure. It can occur during electrophysiology procedures due to radiofrequency ablation, lead or catheter manipulation, transseptal puncture, laser lead extractions, or left atrial appendage occlusion device positioning. Cardiac tamponade is difficult to study in a prospective manner, and case reports and case series are important contributions to understanding the best options for patient care. An 87-year-old Caucasian male patient breathing spontaneously developed acute tamponade during an atrial flutter ablation. Pericardial drain insertion was difficult, and hypotension failed to respond to epinephrine boluses. The patient became hypoxemic and hypercarbic, requiring intubation. Unexpectedly, the blood pressure markedly increased postintubation and remained in a normal range until the pericardium was drained. Spontaneous ventilation is considered important to maintain venous return to the right heart during cardiac tamponade. However, spontaneous ventilation reduces venous return to the left heart and worsens the paradoxical pulse in tamponade. Intravenous vasopressors are thought to be ineffective during cardiac tamponade. Our patient maintained pulmonary blood flow as indicated by end-tidal carbon dioxide measurements but had no measurable systemic blood pressure during spontaneous ventilation. Our case demonstrates that tracheal intubation and positive pressure ventilation can transiently improve left heart venous return, systemic perfusion, and drug delivery to the systemic circulation.