Surgical Repair of Cardiac Chamber Injury by Catheter Ablation for Atrial Fibrillation

Abstract

Background: Cardiac tamponade developing in the catheter ablation procedure is a very rare complication, but might result in the fatal outcome unless the prompt diagnosis and appropriate treatments are done. There are few published reports regarding the surgical intervention for this critical complication. Objective and Methods: From January 2012 to December 2021, 10 patients underwent emergency surgical repair of cardiac chamber injuries by atrial fibrillation catheter ablation. The trends of the injury and the strategy of the emergency surgery were assessed. Results: All the patients were successfully rescued by emergency surgical repair. Two of them underwent the surgery under cardiopulmonary bypass. There were 12 injury sites including 5 of left atrium and left atrial appendage. Intraoperative findings suggested that the cause of the cardiac tamponade was mainly due to mechanical chamber injury by ablation catheter manipulations in all cases. Four patients who were all octogenarians necessitated prolonged hospitalization due to disuse syndrome secondary to acute renal failure postoperatively. Conclusions: Cardiac chamber injury by catheter ablation for atrial fibrillation could be surgically repaired by the evaluation of pre-operative dynamic state and predictive diagnosis of injury sites. Pre-operative evaluation of drained pericardial blood gas analysis and hemodynamic state provide helpful information to organize surgical strategies. The left atrial roof seems to be easily injured because of anatomical reasons and the contact force of the ablation catheter. Pre-operative cardiogenic shock status was suspected as the principal cause of the post-operative complication. Owing to the pre-operative dynamic instability, aged patients in particular might suffer from serious complication such as acute renal injury followed by disuse syndrome. Mutual collaboration with cardiologists should lead to prompt and exact treatment.