Chest Pain following Cardiac Ablation

1 Aug

RAGING HYPOTHETICAL:

Your next patient is a 67 year old female presents complaining of chest pain starting at rest.  

Just yesterday, she underwent limited radiofrequency cardiac ablation for atrial fibrillation.  

No other associated symptoms, exam is benign (No murmurs, rubs, or gallops).  

You order your typical cardiac workup: the ECG is normal, CXR unremarkable, and your troponin comes back at 1.09.  You even get a quick bedside ECHO, which shows a small pericardial effusion without evidence of tamponade.  What now? 

 

POST-CARDIAC ABLATION TIDBITS

Small elevations in troponin are normal following cardiac ablation.

A study by Haegeli et al measured troponins in 60 patients pre and post cardiac ablation.

  • All participants had a normal (<0.01) level pre-procedure
  • all participants had an elevated (range 0.26-1.57, mean 0.85) level post-procedure. 
  • This change was statistically significant for all patients. 

Another study by Chen et al studied the incidence of pericardial effusion following cardiac ablation.

  • Incidence of pericardial effusion was 10.3% (16/156) post atrial fibrillation ablation. 
  • Only 1/156 (0.6%) patients developed cardiac tamponade requiring intervention.   
  • The pericardial effusion disappeared after 3 months in 6 patients and after 6 months in 9 patients. 
  • Female gender and coronary sinus ablation were independent risk factors for pericardial effusion.

 

Take Home Points on Post-Ablation patients:

  • Standard chest pain work up should be performed to rule out any potentially life threatening causes (cardiac puncture, arrhythmia, ACS, PE, esophageal injury)
  • Pericarditis is extremely common following cardiac ablation (approaches 100%)
  • Mild elevations in troponin are common – anything higher than 1.5 should raise suspicion for alternate causes
  • Pericardial effusions are also common following cardiac ablation – if there is no tamponade or hemodynamic changes there is likely no intervention required

 

Submitted by K. Dabrowski.

 

Sourceshttp://www.ncbi.nlm.nih.gov/pubmed/18174208 – Cardiac injury after percutaneous catheter ablation for atrial fibrillation; http://www.ncbi.nlm.nih.gov/pubmed/19102861 – Incidence, risk factors and management of pericardial effusion post radiofrequency catheter ablation in patients with atrial fibrillation.; picture

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