Yoshizawa Tomoharu, Niwano Shinichi, Fukaya Hidehira, Saitoh Daiki, Fujiyoshi Kazuhiro, Nakamura Hironori, Igarashi Tazuru, Oikawa Jun, Satoh Akira, Kishihara Jun, Ako Junya
Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
J Cardiol Cases. 2019 May 10;20(1):27-29. doi: 10.1016/j.jccase.2019.03.004. eCollection 2019 Jul.
It is known that the efficacy of catheter ablation for atrial fibrillation (AF) is high, but cardiac tamponade may occur in 1-2% cases. Even in such cases, fatal condition can be avoided by appropriate drainage, but reversal of anticoagulation therapy might also be necessary. Here, we report a case of use of idarucizumab for cardiac tamponade during AF ablation. Although the drainage with pericardial centesis should be selected, we could not perform because echo free space was too thin at least at the precordial or apical side of the ventricle. Fortunately, dabigatran reversal by idarucizumab suppressed cardiac tamponade progress and the patient recovered without undergoing any invasive procedures. The pericardial drainage must be the principal therapy for cardiac tamponade, but reversal of anticoagulant might be helpful for patients' recovery. It might be thought that dabigatran, the only direct oral anticoagulant with a specific reversal agent, should be the safest choice in case of risk for bleeding complications such as AF ablation. < Cardiac tamponade is one of the complications of catheter ablation for atrial fibrillation (AF). In such cases, fatal condition can be avoided by appropriate drainage, but reversal of anticoagulation therapy might be necessary. Drainage with pericardial centesis was not selected because echo free space was too thin. Dabigatran reversal by idarucizumab suppressed cardiac tamponade progress. It was thought that dabigatran would be the safest choice in case of bleeding complications during AF ablation.>.
已知导管消融治疗心房颤动（AF）的疗效很高，但心脏压塞可能发生在1%-2%的病例中。即使在这种情况下，通过适当引流可避免致命情况，但也可能需要逆转抗凝治疗。在此，我们报告1例在房颤消融期间使用依达赛珠单抗治疗心脏压塞的病例。虽然应选择心包穿刺引流，但由于至少在心室的心前区或心尖侧无回声区太薄，我们无法进行引流。幸运的是，依达赛珠单抗逆转达比加群抑制了心脏压塞的进展，患者未接受任何侵入性操作即康复。心包引流必须是心脏压塞的主要治疗方法，但逆转抗凝剂可能有助于患者康复。可能会认为，达比加群是唯一具有特异性逆转剂的直接口服抗凝剂，在发生诸如房颤消融等出血并发症风险的情况下应是最安全的选择。<心脏压塞是导管消融治疗心房颤动（AF）的并发症之一。在这种情况下，通过适当引流可避免致命情况，但可能需要逆转抗凝治疗。未选择心包穿刺引流是因为无回声区太薄。依达赛珠单抗逆转达比加群抑制了心脏压塞的进展。人们认为在房颤消融期间发生出血并发症的情况下，达比加群将是最安全的选择。>
