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In a randomized trial, pulsed field ablation was noninferior to cryoballoon ablation with respect to the incidence of a first recurrence of atrial tachyarrhythmia, as assessed by continuous rhythm monitoring.

In this trial, patients with tuberculous pericarditis were randomly assigned to prednisolone or placebo and to Mycobacterium indicus pranii or placebo. Neither therapy reduced the risk of the composite outcome of death, cardiac tamponade, or constrictive pericarditis. Tuberculous pericarditis is a common cause of pericardial effusion, cardiac tamponade, and constrictive pericarditis in sub-Saharan Africa and parts of Asia. 1 – 3 Patients with tuberculous pericarditis often have concomitant human immunodeficiency virus (HIV) infection. 1 Despite antituberculosis therapy, pericardial drainage, or pericardiectomy, mortality and morbidity remain high. 4 Mortality is as high as 26% at 6 months but is even higher (approximately 40%) among persons with the acquired immunodeficiency syndrome. 5 The use of glucocorticoid therapy in patients with tuberculous pericarditis to attenuate the inflammatory response may improve outcomes and decrease the risk of death by reducing cardiac tamponade and pericardial constriction, 6 but . . .

Cardiac tamponade (CT) has an atypical presentation in patients with underlying pulmonary hypertension (PH). Evidence regarding the impact of PH on CT in-hospital outcomes is lacking. We used the National Inpatient Sample database to identify adult hospitalizations with a diagnosis of CT between 2016 and 2020, using relevant ICD-10 diagnostic codes. Baseline characteristics and in-hospital outcomes were compared in patients with and without a PH. Multivariate logistic regression analyses and case-control matching were performed, adjusting for age, race, gender, and statistically significant co-morbidities between cohorts. A total of 110,285 inpatients with CT were included, of which 8,670 had PH. Patients with PH tended to be older (66 ± 15.7) and female (52.5%), had significantly higher rates of hypertension (74% vs 65%), CAD (36.9% vs. 29.6%), CKD (39% vs 23%), DM (32.1%, vs. 26.9%), chronic heart failure (19.0% vs 9.7%) and COPD (26% vs 18%)(P<0.001 for all). After multivariate logistic regression, PH was associated with higher all-cause mortality (aOR 1.29; 95% CI: 1.11-1.49), higher rates of cardiogenic shock (aOR: 1.19; 95% CI: 1.01-1.41), ventricular arrythmias (aOR: 1.63; 95% CI: 1.33-2.01), longer length of stay (11 days vs 15 days), and higher total hospitalization costs ($228,314 vs $327,429) in patients presenting with CT. Despite pericardiocentesis being associated with lower in-hospital mortality, patients with PH were less likely to undergo pericardiocentesis (aOR: 0.77; 95% CI: 0.69-0.86). PH was associated to increased in-hospital mortality and a higher rate of cardiovascular complications in an inpatient population with CT. Pericardiocentesis was associated with reduced mortality in patients with CT, regardless of whether they had PH. However, patients with PH underwent pericardiocentesis less frequently than those without PH.

ObjectivesPericardial effusion is common after cardiac surgery. Growing evidence suggests that colchicine may be useful for acute pericarditis, but its efficacy in reducing pericardial effusion volume postoperatively has not been assessed.MethodsThis randomised, double-blind, placebo-controlled study conducted in 10 centres in France included 197 patients at high risk of tamponade (ie, with moderate to large-sized persistent effusion (echocardiography grades 2, 3 or 4 on a scale of 0–4)) at 7–30 days after cardiac surgery. Patients were randomly assigned to receive colchicine, 1 mg daily (n=98), or a matching placebo (n=99). The main end point was change in pericardial effusion grade after 14-day treatment. Secondary end points included frequency of late cardiac tamponade.ResultsThe placebo and the colchicine groups showed a similar mean baseline pericardial effusion grade (2.9±0.8 vs 3.0±0.8) and similar mean decrease from baseline after treatment (−1.1±1.3 vs −1.3±1.3 grades). The mean difference in grade decrease between groups was −0.19 (95% CI −0.55 to 0.16, p=0.23). In total, 13 cases of cardiac tamponade occurred during the 14-day treatment (7 and 6 in the placebo and colchicine groups, respectively; p=0.80). At 6-month follow-up, all patients were alive and had undergone a total of 22 (11%) drainages: 14 in the placebo group and 8 in the colchicine group (p=0.20).ConclusionsIn patients with pericardial effusion after cardiac surgery, colchicine administration does not reduce the effusion volume or prevent late cardiac tamponade.Clinical trial reg NoNCT01266694.

Background Acute cardiac tamponade is a rare but fatal complication after video-assisted thoracoscopic surgery. This case is noteworthy for its novel mechanism of injury and underscores the critical importance of multidisciplinary management in achieving a successful outcome against high historical mortality rates. Case presentation A 64-year-old Han Chinese male underwent an uncomplicated video-assisted thoracoscopic surgery right upper lobe wedge resection for lung adenocarcinoma. At 3 hours postoperatively, he developed sudden obstructive shock. Echocardiography confirmed cardiac tamponade. Emergent pericardiocentesis and venoarterial extracorporeal membrane oxygenation stabilization were followed by sternotomy, which revealed a needle-like aortic perforation caused by a malformed staple that had eroded from the pulmonary staple line. The aortic injury was surgically repaired. The patient was successfully weaned from extracorporeal membrane oxygenation on postoperative day 2 and extubated on day 7, making a full recovery, and was discharged on day 19. Conclusion This case highlights a novel, delayed mechanism of staple-related vascular injury that can occur even after right-sided video-assisted thoracoscopic surgery. It demonstrates that rapid diagnosis, immediate pericardiocentesis, early extracorporeal membrane oxygenation support, and definitive surgical repair within a multidisciplinary framework are paramount for survival. This report advocates for heightened vigilance during stapling near vital structures and reinforces the lifesaving potential of a protocolized rescue approach.

In the midst of the COVID-19 pandemic, further understanding of its complications points towards dysregulated immune response as a major component. Systemic lupus erythematosus (SLE) is also a disease of immune dysregulation leading to multisystem compromise. We present a case of new-onset SLE concomitantly with COVID-19 and development of antiphospholipid antibodies. An 18-year-old female that presented with hemodynamic collapse and respiratory failure, progressed to cardiac arrest, and had a pericardial tamponade drained. She then progressed to severe acute respiratory distress syndrome, severe ventricular dysfunction, and worsening renal function with proteinuria and hematuria. Further studies showed bilateral pleural effusions, positive antinuclear and antidouble-stranded DNA antibodies, lupus anticoagulant, and anticardiolipin B. C3 and C4 levels were low. SARS-Cov-2 PCR was positive after 2 negative tests. She also developed multiple deep venous thrombosis, in the setting of positive antiphospholipid antibodies and lupus anticoagulant. In terms of pathophysiology, COVID-19 is believed to cause a dysregulated cytokine response which could potentially be exacerbated by the shift in Th1 to Th2 response seen in SLE. Also, it is well documented that viral infections are an environmental factor that contributes to the development of autoimmunity; however, COVID-19 is a new entity, and it is not known if it could trigger autoimmune conditions. Additionally, it is possible that SARS-CoV-2, as it happens with other viruses, might lead to the formation of antiphospholipid antibodies, potentially contributing to the increased rates of thrombosis seen in COVID-19.

BackgroundDespite continued efforts to improve the safety of catheter ablation, pericardial tamponade remains one of its more frequent, potentially life-threatening complications. Management of cardiac tamponade is not standardized and uncertainties regarding acute treatment remain.MethodsThis survey sought to evaluate the management of cardiac tamponade in German EP centers via a standardized postal questionnaire. All 341 identified German EP centers were invited to return a questionnaire on their standards for the management of cardiac tamponade.ResultsA total of 189 German EP centers completed the questionnaire. Several precautions are followed to avoid pericardial tamponade: A minority of centers preclude very old patients (19%) or those with a high body mass index (30%) from ablation. Non-vitamin K antagonist oral anticoagulants are briefly paused in most centers (88%) before procedures, while vitamin K antagonists are continued. Pericardial tamponade is usually treated using reversal of heparin by applying protamine (86%) and pericardiocentesis under both, fluoroscopic and echocardiographic guidance (62%). A pigtail catheter is mostly inserted (97%) and autotransfusion of aspirated blood is performed in 47% of centers. The decision for surgical repair depends on different clinical and infrastructural aspects. The timing of reinitiation of anticoagulation widely differs between the centers. Approximately 1/3 of centers prescribe nonsteroidal anti-inflammatory agents, colchicine or steroids after pericardiocentesis.ConclusionThe present survey shows that the management of cardiac tamponade is still inhomogeneous in German ablation centers. However, multiple findings of this survey can be generalized and might guide especially less experienced operators and centers in their treatment and decision strategies.

In patients with biliary or pancreatic disease, endoscopic retrograde cholangiopancreatography (ERCP) is a common and important therapeutic and diagnostic procedure. Stent migration is a possible complication occurring in approximately 5–10% of cases. This case presents a 47-year-old male with chest pain and found to have biliary stent migration to the pericardial sac causing septic pericarditis and cardiac tamponade. Highlighting this devastating complication, this case demonstrates an opportunity for emergency physicians (EP) to diagnose and monitor patients for post-operative and post-procedural complications. In the emergency department, EPs are well positioned to use ultrasound as a diagnostic and monitoring tool for cardiac tamponade. •Kate Simeon certifies that they have no competing interests or financial disclosures.•Angela Wright certifies that they have no competing interests or financial disclosures.•Vaughn Browne certifies that they have no competing interests or financial disclosures.

Acute cardiac tamponade is life threatening and requires prompt pericardial drainage. This review explains the manifestations of tamponade, including a presentation in which the diagnostic finding of pulsus paradoxus is absent, and variant forms, such as low-pressure tamponade and regional tamponade. Cardiac tamponade is life-threatening, slow or rapid compression of the heart due to the pericardial accumulation of fluid, pus, blood, clots, or gas, as a result of effusion, trauma, or rupture of the heart. 1 , 2 Because the causes of pericardial disease 1 and thus of tamponade are diverse, clinicians must choose the most probable diagnosis, always anticipating surprises. Thus, traumatic tamponade is most apt to follow cardiac surgery, and tuberculous tamponade is relatively common in Africa but rare in the United States. Understanding the physiological changes produced by tamponade is essential to diagnosis and treatment. 3 – 12 The primary abnormality is rapid . . .