Pericardial effusion caused by accidently placing a Micra transcatheter pacing system into the coronary sinus

Abstract Background Leadless pacemaker has been acknowledged as a promising pacing strategy to prevent pocket and lead-related complications. Although rare, cardiac perforation remains a major safety concern for implantation of Micra transcatheter pacing system (TPS). Case presentation A 83-year-old female with low body mass index (18.9 kg m−2) on dual anti-platelet therapy, was indicated for Micra TPS implantation due to sinus arrest and paroxysmal atrial flutter. The patient developed mild pericardial effusion during the procedure since the delivery catheter was accidentally placed into the coronary sinus for several times. Cardiac perforation with moderate pericardial effusion and pericardial tamponade was detected 2 h post-procedure. The patient was treated with immediately pericardiocentesis and recovered without further invasive therapy. Conclusion Pericardial effusion caused by accidently placing a delivery catheter into the coronary sinus is rare but should be carefully considered in Micra TPS implantation, especially for those with periprocedural anti-platelet therapy.

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Abstract 16795: Fate of Dislodged Micra Transcatheter Pacing System in Coronary Sinus

Circulation ◽

10.1161/circ.142.suppl_3.16795 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Sangeeta Prabhakar Bhat ◽

Vijay Pratap Singh ◽

Wilson Young

Keyword(s):

Atrial Fibrillation ◽

Coronary Sinus ◽

Persistent Atrial Fibrillation ◽

Case Presentation ◽

Leadless Pacemaker ◽

Device Implantation ◽

Ventricular Response ◽

Chest X Ray ◽

Symptomatic Bradycardia ◽

The Right

Background: Micra Transcatheter Pacing System is a leadless pacemaker for treatment of symptomatic high-grade atrioventricular block and persistent atrial fibrillation. We present a case report of dislodgement of a Micra device into the coronary sinus. Case presentation: An 87 year old man with permanent atrial fibrillation presented to the hospital with dizziness and fall. His medications included Lasix and Metoprolol. Electrocardiogram revealed atrial fibrillation with slow ventricular response. Metoprolol was held. During the hospital stay, telemetry monitoring revealed heart rates of 30-40 bpm. Micra device implantation was indicated for symptomatic bradycardia. After deployment, the Micra dislodged into the right atrium. Efforts to retrieve the device led to its embolism into mid-coronary sinus and dissection of the coronary sinus. Given comorbidities, the Micra was deactivated and a single chamber pacemaker was implanted with serial radiographic monitoring of Micra. Post procedure Chest X-ray (Fig. 1) and Computed Tomography Angiography of the chest (Fig. 2) confirmed location of Micra in the coronary sinus. Discussion: This is the first described case of dislodged Micra device in the coronary sinus. Device retrieval attempts resulted in dissection of the coronary sinus and there was no myocardial capture when pacing from the device. Serial CXR showed stable Micra position over the next two years. Conclusion: Embolization and dislodgement of Micra leadless pacemaker into the coronary sinus is possible and chronic management with serial imaging after abandoning the device is feasible.

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Insufficient procedural anticoagulation during leadless pacing led to catheter-related thrombosis in a hemodialysis patient

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02318-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Qiang Chen ◽

Yong Jiang Ma ◽

Chun Hong Zhang ◽

Li Wei Zhang

Keyword(s):

Hemodialysis Patient ◽

Thrombus Formation ◽

Pacemaker Implantation ◽

Case Presentation ◽

Leadless Pacemaker ◽

Procedural Complications ◽

Diabetic Gangrene ◽

Leadless Pacing ◽

Catheter Related Thrombosis ◽

Delivery Catheter

Abstract Background Leadless pacemaker was a promising innovation than traditional transvenous pacemaker, the procedural complications were prone to be bleeding-related. However, very few reports also concerned about the thrombus formation during the procedure. Case presentation A hemodialysis patient with diabetic gangrene of right foot suffered from catheter-related thrombosis during leadless pacing, resulting in failure of recapture the pacemaker. A low activated clotting time (ACT) level of 104 s confirmed the insufficiency of anticoagulation. Finally, the whole delivery catheter had to be removed from the delivery sheath, another new pacemaker system was applied and successfully implanted after adjusting the ACT level to 248 s. Conclusion Catheter-related thrombosis could be a large obstacle for leadless pacemaker implantation. In addition to routine anticoagulation, ACT monitoring might be necessary during the procedure.

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An asymptomatic child of pre-perforation erosion after transcatheter closure of atrial septal defect

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01646-0 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Wen-long Zhang ◽

Fei Liang

Keyword(s):

Risk Factor ◽

Pericardial Effusion ◽

Early Detection ◽

Atrial Septal Defect ◽

Septal Defect ◽

Transcatheter Closure ◽

Pericardial Tamponade ◽

Asymptomatic Child ◽

Case Presentation

Abstract Background Fatal pericardial tamponade caused by aortic or atrial perforation due to erosion of atrial septal occluders has been reported previously, but the timing of erosion is uncertain, and the process is also unclear. Case presentation We present a case of a 5-year-old boy with erosion of the aorta and atrium by the occluder not leading to perforation or pericardial tamponade because of early detection and timely surgery. A small amount of pericardial effusion may be the only manifestation of early erosion. This case firstly revealed the early process of device erosion in children. Conclusions An absent aortic rim may be a higher risk factor for erosion than oversized device for a child, and it is wise to choose a relatively small occluder or change to surgery. This may be helpful for preventing and treating serious complications caused by erosion of the occluder.

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Central Venous Catheter-Associated Pericardial Tamponade in a 6-Day Old: A Case Report

International Journal of Pediatrics ◽

10.1155/2009/910208 ◽

2009 ◽

Vol 2009 ◽

pp. 1-4 ◽

Cited By ~ 4

Author(s):

Swati O. Arya ◽

Gurumurthy M. Hiremath ◽

Kingsley C. Okonkwo ◽

Michael D. Pettersen

Keyword(s):

Pericardial Effusion ◽

Biochemical Analysis ◽

Venous Catheter ◽

Central Line ◽

Meconium Aspiration Syndrome ◽

Pericardial Tamponade ◽

Central Venous ◽

Case Presentation ◽

Hemodynamic Compromise ◽

Large Pericardial Effusion

Introduction. Pericardial effusion (PCE) and tamponade can cause significant morbidity and mortality in neonates. Such cases have been reported in the literature in various contexts.Case Presentation. A 6-day old neonate with meconium aspiration syndrome and persistent pulmonary hypertension of newborn on high frequency oscillator ventilation and inhaled nitric oxide was referred to our hospital with a large pericardial effusion causing hemodynamic compromise. Prompt pericardiocentesis led to significant improvement in the cardio-respiratory status and removal of the central line prevented the fluid from reaccumulating. Cellular and biochemical analysis aided in the diagnosis of catheter related etiology with possibility of infusate diffusion into the pericardial space.Conclusion. We present this paper to emphasize the importance of recognizing this uncommon but serious complication of central venous catheters in intensive care units. We also discuss the proposed hypothesis for the mechanism of production of PCE.

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An asymptomatic child of pre-perforation erosion after transcatheter closure of atrial septal defect: A case report

10.21203/rs.3.rs-43583/v1 ◽

2020 ◽

Author(s):

Wen-long Zhang ◽

Fei Liang

Keyword(s):

Risk Factor ◽

Case Report ◽

Pericardial Effusion ◽

Early Detection ◽

Atrial Septal Defect ◽

Septal Defect ◽

Transcatheter Closure ◽

Pericardial Tamponade ◽

Asymptomatic Child ◽

Case Presentation

Abstract BackgroundFatal pericardial tamponade caused by aortic or atrial perforation due to erosion of atrial septal occluders has been reported previously,but the timing of erosion is uncertain, and the process is also unclear. Case presentation We present a case of a 5-year-old boy with erosion of the aorta and atrium by the occluder not leading to perforation or pericardial tamponade because of early detection and timely surgery. A small amount of pericardial effusion may be the only manifestation of early erosion.This case firstly revealed the early process of device erosion in children.ConclusionsAn absent aortic rim may be a higher risk factor for erosion than oversized device for a child,and it is wise to choose a relatively small occluder or change to surgery.This may be helpful for preventing and treating serious complications caused by erosion of the occluder.

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The Diagnostic Value of Pericardial Fluid and Pericardial Biopsy: Single Center Experiences

The Heart Surgery Forum ◽

10.1532/hsf.1328 ◽

2016 ◽

Vol 19 (1) ◽

pp. 023 ◽

Cited By ~ 2

Author(s):

Mehmet Yildirim ◽

Recep Ustaalioglu ◽

Murat Erkan ◽

Bala Basak Oven Ustaalioglu ◽

Hatice Demirbag ◽

...

Keyword(s):

Pericardial Effusion ◽

Thoracoscopic Surgery ◽

Pericardial Tamponade ◽

Pericardial Fluid ◽

Pathological Examination ◽

Common Disease ◽

Pericardial Window ◽

Surgical Interventions ◽

History Of ◽

Recurrent Pericardial Effusion

Background: Patients with recurrent pericardial effusion and pericardial tamponade are usually treated in thoracic surgery clinics by VATS (video-assisted thoracoscopic surgery) or open pericardial window operation. The diagnostic importance of pathological evaluation of the pericardial fluid and tissue in the same patients has been reported in few studies. We reviewed pathological examination of the pericardial tissue and fluid specimens and the effect on the clinical treatment in our clinic, and compared the results with the literature. Methods: We retrospectively analyzed 174 patients who underwent pericardial window operation due to pericardial tamponade or recurrent pericardial effusion. For all patients both the results of the pericardial fluid and pericardial biopsy specimen were evaluated. Clinicopathological factors were analyzed by using descriptive analysis. Results: Median age was 61 (range, 20-94 years). The most common benign diagnosis was chronic inflammation (94 patients) by pericardial biopsy. History of malignancy was present in 28 patients (16.1%) and the most common disease was lung cancer (14 patients). A total of 24 patients (13.8%) could be diagnosed as having malignancy by pericardial fluid or pericardial biopsy examination. The malignancy was recognized for 12 patients who had a history of cancer; 9 of 12 with pericardial biopsy, 7 diagnosed by pericardial fluid. Twelve of 156 patients were recognized as having underlying malignancy by pericardial biopsy (n = 9) or fluid examination (n = 10), without known malignancy previously. Conclusion: Recurrent pericardial effusion/pericardial tamponade are entities frequently diagnosed, and surgical interventions may be needed either for diagnosis and/or treatment, but specific etiology can rarely be obtained in spite of pathological examination of either pericardial tissue or fluid. For increasing the probability of a specific diagnosis both the pericardial fluid and the pericardial tissues have to be sent for pathologic examination.

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A Meta-analysis for Major Complications Between Traditional Pacemaker and Leadless Pacemaker

10.21203/rs.2.13606/v1 ◽

2019 ◽

Author(s):

Diyu Cui ◽

Xiaorui Chen ◽

Lin Wang ◽

Yimeng Liao ◽

Huan He ◽

...

Keyword(s):

Clinical Practice ◽

Meta Analysis ◽

Cochrane Library ◽

Good Prospect ◽

Vascular Events ◽

Pacing Threshold ◽

Cardiac Perforation ◽

Leadless Pacemaker ◽

Major Complications ◽

Significant Difference

Abstract Objectives To compare the major complications between leadless pacemaker (LP) and traditional pacemakers(TP).Background The TP shows some advantages in avoiding pocket- and lead-related complications over the TP and is increasingly used in clinical practice. However, the clinical effect of LP remains controversial.Methods PUBMED、EMBASE、The COCHRANE LIBRARY、CNKI and WANGFANG databases were searched from July 2013 to August 2018. Data concerning the study’s design, patients’ characteristics and outcomes were extracted. The primary end-point is the major complications. The second end-points are elevated pacing threshold, cardiac perforation/effusion, device dislodgement and vascular events.Results A total of 6 studies fulfilled the inclusion criteria. Only 4 of which can provide the data of major complications. The main complications of LP were statistically significantly decreased compared with that of TP(OR 0.41,95%CI:0.29-0.56,P<0.00001,I2=42%).We extracted the data of elevated pacing threshold, cardiac perforation/effusion, device dislodgement and vascular events in 4 other of these 6 studies. There was no significant difference in elevated pacing threshold (OR 0.95, 95%CI:0.24-3.70,P=0.94, I2=31%), cardiac perforation/effusion(OR 1.78,95%CI:0.33-9.58, P=0.50,I2=87%), vascular events (OR1.58, 95%CI:0.45-5.53, P=0.47,I2=47%) and device dislodgement(OR 0.22,95%CI:0.01-5.69,P=0.36,I2=81%) between LP and TP.Conclusion Compared with TP, LP showed a significantly decreased risk in major complications. This indicates that LP has a good prospect to be applicated in clinical practice.

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A Meta-analysis of Major Complications between Traditional Pacemakers and Leadless Pacemakers

Cardiovascular Innovations and Applications ◽

10.15212/cvia.2019.0596 ◽

2020 ◽

Author(s):

Yun-Qing Chen

Keyword(s):

Pericardial Effusion ◽

Risk Ratio ◽

Clinical Effect ◽

Meta Analysis ◽

Cochrane Central Register ◽

Inclusion Criteria ◽

Cardiac Perforation ◽

Major Complications ◽

Central Register ◽

Reported Data

Objectives: We aim to compare the major complications between leadless pacemakers and traditional pacemakers.Background: Leadless pacemakers, which are increasingly used in clinical practice, have several advantages compared with traditional pacemakers in avoiding pocket- and lead-related complications. However, the clinical effect of leadless pacemakers remains controversial.Methods: PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the CNKI database, and the Wanfang database were searched from July 2013 to December 2019. Studies comparing leadless pacemakers and traditional pacemakers were included. The primary end point was major complications. The secondary end points were cardiac perforation/pericardial effusion, device revision or extraction, loss of device function, and death.Results: Six studies fulfilled the inclusion criteria. Only four of the six studies reported data on major complications.Leadless pacemakers were associated with a lower incidence of major complications (risk ratio 0.33, 95% confidenceinterval 0.25–0.44, P < 0.00001, I² = 49%). We extracted data on cardiac perforation/pericardial effusion, device revisionor extraction, loss of device function, and death from six studies. Our meta-analysis showed that leadless pacemakershave a higher risk of cardiac perforation or pericardial effusion (risk ratio 4.28, 95% confidence interval 1.66–11.08,P = 0.003, I² = 0%). No statistically significant differences were found for mortality, device revision or extraction, andloss of device function.Conclusion: Compared with traditional pacemakers, leadless pacemakers have a significantly decreased risk of majorcomplications, but have a higher risk of cardiac perforation or pericardial effusion.

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Abstract 16344: Pericardial Complications in Patients With COVID-19: A Systematic Review of Published Cases

Circulation ◽

10.1161/circ.142.suppl_3.16344 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Sandeep Singh ◽

Akhil Jain ◽

Priyanka Chaudhari ◽

Faizan Ahmad Malik ◽

Virmitra Desai ◽

...

Keyword(s):

Heart Failure ◽

Pericardial Effusion ◽

Cardiac Tamponade ◽

Troponin I ◽

Case Reports ◽

Cardiac Injury ◽

Pericardial Tamponade ◽

Time Interval ◽

Cardiac Damage ◽

St Segment Elevation

Introduction: COVID-19 has been linked to cardiac damage and life-threatening pericardial complication on which data are trivial which incited us to perform this review of published case reports. Methods: PubMed/Medline, Web of Science and SCOPUS were searched until June 2020 for case reports on COVID-19-associated pericarditis, cardiac tamponade or pericardial effusion. Results: We identified 8 articles reporting 11 COVID-19 positive cases [mean age: 51.4±14.3 (34-78 yrs) 5 male/6 female)] with pericardial complications. All (100%) cases were COVID-19 positive at the presentation with ~80% having dyspnea, chest pain and cough. Time interval from first symptom to pericardial effusion was 7±8 (1-26) days. Five patients reported heart failure with reduced EF on echocardiography with mean LVEF 36.25%±8.54%. All patients showed nearly normal Troponin-I without angiographically significant stenosis except one. Out of 8 cases on echocardiography 4 cases reported with diffuse hypokinesia, 2 reported inferior and inferolateral walls hypokinesia and 2 reported signs of pericardial tamponade. Out of 11 patients, cardiovascular risk factors in the form of diabetes or hypertension or obesity were present in 5 patients. Cardiovascular comorbidities such as heart failure with low ejection fraction, non-ischemic cardiomyopathy and prior myocarditis were present in 3 patients. ST-segment elevation in 3, sinus tachycardia in 2, T wave inversion in 1 case were noted. Four patients developed cardiac tamponade, 1 developed takotsubo syndrome and 3 patients died. Conclusions: COVID-19 patients had signs of a high burden of cardiac injury. Pericardial complications (pericardial effusion and cardiac tamponade) remain infrequent complications which may require prompt care to avoid mortality.

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The pericardium and pericardial disease

Practical Perioperative Transoesophageal Echocardiography ◽

10.1093/med/9780198759089.003.0016 ◽

2018 ◽

Author(s):

David Sidebotham ◽

Alan Merry ◽

Malcolm Legget ◽

Gavin Wright

Keyword(s):

Pericardial Effusion ◽

Constrictive Pericarditis ◽

Restrictive Cardiomyopathy ◽

Transoesophageal Echocardiography ◽

Pericardial Tamponade ◽

Acute Pericarditis ◽

Pericardial Disease ◽

Mechanically Ventilated ◽

Spectral Doppler ◽

Echocardiographic Assessment

Chapter 16 is a new chapter from earlier editions of Practical Perioperative Transoesophageal Echocardiography. It provides a short summary on the echocardiographic assessment of the normal pericardium and on pericardial disease. The characteristic TOE features of pericardial pathology (cysts, acute pericarditis, pericardial effusion, pericardial tamponade, and constrictive pericarditis) are reviewed. In particular, pericardial constriction is discussed in detail, including outlining the features that distinguish pericardial constriction from restrictive cardiomyopathy. Wherever possible, the spectral Doppler abnormalities associated with pericardial constriction and pericardial tamponade are discussed with reference to patients who are mechanically ventilated.

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