Endo-epicardial AF ablation procedure
Epicardial bleeding and management
Management of pericardial complications during endo-epicardial AF procedures
- •Catheter and sheath manipulation within the pericardial space and delivery of radiofrequency ablation lesions carry a recognized risk for bleeding and hemopericardium, requiring individualized management strategies depending on suspected source of bleed, quantity, and hemodynamic stability.
- •Management of bleeding events in the context of simultaneous endo-epicardial ablation procedures poses a particular challenge owing to the delicate balance between achieving haemostasis while avoiding systemic prothrombotic states facilitating thrombus apposition on endocardial lesions with risk of embolization/stroke.
- •Intrapericardial tranexamic acid can be successfully applied as an adjunctive therapy for promoting local hemostasis in a subset of iatrogenic epicardial bleeds without increasing risk of endocardial thrombus formation.
- •Early involvement of the cardiac surgical team is always advisable for multidisciplinary decision-making and prevention of unnecessary delays in case of ongoing uncontrolled bleeding requiring surgical intervention.
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