https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Münster Klinik für Kardiologie II - Rhythmologie Münster, Deutschland; 2Asklepios Klinik St. Georg Kardiologie & internistische Intensivmedizin Hamburg, Deutschland; 3Evangelisches Krankenhaus Düsseldorf Klinik für Kardiologie Düsseldorf, Deutschland; 4Universitätsklinikum Düsseldorf Klinik für Kardiologie, Pneumologie und Angiologie Düsseldorf, Deutschland; 5LMU Klinikum der Universität München Medizinische Klinik und Poliklinik I München, Deutschland; 6Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie Hamburg, Deutschland; 7Cardiance Clinic Pfäffikon SZ, Schweiz
OBJECTIVE AND BACKGROUND: Incidences of pericardial tamponade after catheter ablation (CA) vary and depend on the type of the treated arrhythmia. As current socio-economic burden and demand for interventional therapies of cardiac arrhythmias rise, demands for same-day discharges have been postulated. But evidence of safety in this regard is scarce. Therefore, we aimed at analyzing temporal trends of pericardial tamponades after catheter ablation for cardiac arrhythmias.
METHODS: We determined the incidences of pericardial tamponades needing intervention after ablation for atrial fibrillation (AF), atrial flutter (AFLU), and ventricular tachycardia (VT) therapy in four German tertiary centers between 2005-2020. All cases were coded by the G-DRG- and OPS-systems. Uniform code search terms were applied defining both the types of ablations for AF, AFL, and VT and the occurrence of tamponades. Importantly, all cases were thereafter individually reviewed based on patient-level source records.
RESULTS: Overall, 43,031 ablations were analyzed (30,361 AF; 9,364 AFL; 3,306 VT). Pericardial tamponades needing intervention occurred in 0.7 % (n=300), most after VT ablation procedures (n=73; 2,2%). Upon patient level review of each case, most tamponades occurred on the day of the procedure (n=184; 91.1%), of which 122 (66.3%) occurred intraprocedurally. The remaining tamponades either occurred/were drained on the day after (n= 14, 6.9 %) or > 2 days after the procedure (n=4, 2.0%). In seven patients (2.3% of those with a tamponade), the ablation-associated tamponade was considered causally related to death.
CONCLUSION: With almost 10 % of severe cardiac tamponades requiring drainage occurring either the day after or > 2 days after the procedure, the safety of same-day discharge after catheter ablation of cardiac arrhythmias may be questioned. Large prospective randomized trials are still needed before general recommendation of same-day-discharge in catheter ablation of complex arrhythmias.