Delayed cardiac tamponade (DCT) is a rare and life-threatening complication of catheter ablation performed as a treatment of atrial fibrillation, with few cases described in the medical literature. We present the case of a 57year-old man presenting with DCT 61days following a catheter ablation procedure. To the best of our knowledge, this is the most delayed case of cardiac tamponade (CT) following catheter ablation described in the literature. We also discuss the importance of point of care ultrasound (POCUS) in the diagnosis and treatment of CT.

Emergency physicians must maintain a high index of suspicion in making the diagnosis of CT as patients may present with vague symptoms such as neck or back pain, shortness of breath, fatigue, dizziness, or altered mental status, often without chest pain.

Common risk factors for CT include cancer, renal failure, pericarditis, cardiac surgery, myocardial rupture, trauma, and retrograde aortic dissection. In addition, although rare, both catheter ablation and use of anticoagulation carry risks of developing CT. A worldwide survey of medical centers performing catheter ablation found CT as a complication in less than 2% of cases [1Cappato R., Calkins H., Chen S.A., et al. Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation Circ Arrhythm Electrophysiol 2010 ;  3 (1) : 32-3810.1161/CIRCEP.109.859116 [cross-ref]

Cliquez ici pour aller à la section Références]. Some proposed mechanisms of DCT include small pericardial hemorrhages following post-procedural anticoagulation or rupture of the sealed ablation-induced left atrial wall [2Lambert T., Steinwender C., Leisch F., Hofmann R. Cardiac tamponade following pericarditis 18days after catheter ablation of atrial fibrillation Clin Res Cardiol 2010 ;  99 (9) : 595-59710.1007/s00392-010-0174-2 [cross-ref]

Cliquez ici pour aller à la section Références].

Clinical examination and electrocardiography may be helpful. However, the criterion standard for diagnosing CT is echocardiography [3McGinley A., Gribbin G. A delayed diagnosis of cardiac tamponade BMJ Case Rep 2013 ; 10.1136/bcr-2012-007255

Cliquez ici pour aller à la section Références].