Post-cardiac injury syndrome after a concealed accessory pathway ablation

Abstract

The incidence of pericardial effusion for supraventricular tachycardias is less than 1%, and its combination with pleural effusion is rare. We present a case of severe pericardial and pleural effusion after a left-sided concealed accessory pathway ablation. The 480 cc of pericardial fluid was drained with the pericardial drainage system due to cardiac tamponade with hemodynamic compromise. The chest X-ray and thorax computed tomography showed moderate left-sided pleural effusion after pericardiocentesis. We considered the inflammatory response as the pathophysiology of the situation; we started ibuprofen 800 mg t.i.d. and colchicine 0.5 mg o.d. At a 3-week follow-up, her X-ray revealed the resolution of pleural effusion, and the echocardiography showed no pericardial effusion. <Learning objective: Pericardial effusion is rarely seen after cardiac ablations. Despite the mechanism not being well-established, it seems that inflammation plays a critical role. A trial of non-steroidal anti-inflammatory drugs and colchicine can be used safely and seems reasonably effective in this setting.> © 2021