Khan Zahid
Acute Medicine, Mid and South Essex NHS Foundation Trust, Southend on Sea, GBR.
Cardiology, Bart's Heart Center, London, GBR.
Cureus. 2023 Sep 10;15(9):e44989. doi: 10.7759/cureus.44989. eCollection 2023 Sep.
Catheter ablation has become an important treatment strategy for the management of atrial fibrillation (AF) in symptomatic patients. Pulmonary vein isolation (PVI) is increasingly used to restore rhythm in patients with AF and flutter. The serious procedural complication rate has significantly reduced over time and most patients undergo PVI without any adverse events. We present the case of a 70-year-old man with symptomatic AF who underwent elective PVI that was complicated by large pericardial effusion from left atrial appendage (LAA) perforation resulting in cardiac tamponade requiring emergency pericardiocentesis followed by sternotomy to suture the LAA. The perforated LAA was sutured and the LAA was closed surgically through sternotomy by using AtriClip and a large amount of blood was evacuated achieving good cardiac output and hemodynamic stability. A surgical PVI was performed twice restoring normal sinus rhythm. The patient was discharged home, however, he returned to the hospital a few days later with atrial flutter with a rapid ventricular response. He underwent direct current cardioversion (DCCV) and remained in sinus rhythm during the rest of his admission. His bisoprolol was switched to Sotalol to maintain normal sinus rhythm and he was discharged home with outpatient follow-up.
导管消融已成为有症状患者心房颤动（AF）管理的重要治疗策略。肺静脉隔离（PVI）越来越多地用于恢复房颤和房扑患者的心律。随着时间的推移，严重的手术并发症发生率显著降低，大多数患者接受PVI时没有任何不良事件。我们报告一例70岁有症状房颤男性患者，其接受择期PVI，并发左心耳（LAA）穿孔导致大量心包积液，进而引起心脏压塞，需要紧急心包穿刺，随后进行胸骨切开术缝合LAA。对穿孔的LAA进行了缝合，并通过胸骨切开术使用AtriClip将LAA手术关闭，排出大量血液，实现了良好的心输出量和血流动力学稳定性。进行了两次外科PVI，恢复了正常窦性心律。患者出院回家，但几天后因伴有快速心室反应的房扑再次入院。他接受了直流电复律（DCCV），在住院期间其余时间维持窦性心律。将他的比索洛尔换成索他洛尔以维持正常窦性心律，他出院后接受门诊随访。
