Immediate pericardial protamine administration in acute pericardial tamponade

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. AIMS: Cardiac tamponade (CT) is the most common life-threatening complication of interventional electrophysiology. Urgent drainage by percutaneous pericardiocentesis and anticoagulation reversal are required. Immediate direct protamine administration to the pericardial space to the patient has not been described. This study was designed to assess the efficacy and safety of immediate intrapericardial protamine administration (IPPA) in CT as a complication of interventional electrophysiologic procedure. METHODS: A retrospective case series of IPPA performed for CT was collected. Urgent drainage by percutaneous pericardiocentesis and IPPA were performed to achieve hemodynamic stabilization without emergent surgery. RESULTS: Eleven cases of IPPA were included in two tertiary heart centres. Electrophysiological procedures were performed for ventricular tachycardia (n =3), atrial fibrillation (n = 3), left accessory pathway (n = 1), and premature ventricular contraction (n =4) with transseptal (n = 10) and/or retroaortic routes (n =3). Pericardial drainage was performed by percutaneous pericardiocentesis for all 11 patients. Surgical haemostasis was not required for our cohort. The mean volume of drained pericardial fluid was 486ml (200-1200) Mean IPPA dosage was 209mg (100-800). Mean systemic protamine dosage was 86mg(50-100). No complication was observed on the follow-up. CONCLUSION: IPPA is a feasible, safe, and useful technique for salvage therapy in CT. CONCLUSION: IPPA is a feasible, safe, and useful technique for salvage therapy in ACT in interventional electrophysiology. [Figure: see text]