Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2016 Apr;27(4):399-403.
doi: 10.1111/jce.12918. Epub 2016 Feb 17.

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

Carola Gianni  1   2 , Luigi DI Biase  1   3   4   5 , Sanghamitra Mohanty  1 , Chintan Trivedi  1 , Rong Bai  1 , Amin Al-Ahmad  1 , J David Burkhardt  1 , G Joseph Gallinghouse  1 , Rodney P Horton  1   4 , Javier E Sanchez  1 , Patrick M Hranitzky  1 , Dhanunjaya Lakkireddy  6 , Moussa C Mansour  7 , Pasquale Santangeli  8 , Erica S Zado  8 , Francis E Marchlinski  8 , Salwa Beheiry  9 , Steven C Hao  9 , Linda Couts  10 , Douglas Gibson  10 , Andrea Natale  1   3   4   9   10   11   12   13
Affiliations
Case Reports

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

Carola Gianni et al. J Cardiovasc Electrophysiol. 2016 Apr.

Abstract

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.

Keywords: 4-factor prothrombin complex concentrate; apixaban; atrial fibrillation ablation; factor Xa inhibitors; pericardial tamponade; rivaroxaban; uninterrupted anticoagulation.

PubMed Disclaimer

MeSH terms

LinkOut - more resources