Background With the number of complex catheter ablation procedures increasing, procedure-related acute cardiac tamponade is encountered more frequently in the cardiac catheterisation laboratory. Survival depends on prompt recognisation and rescue pericardiocentesis.

Objective The aim of this report was to validate fluoroscopic heart silhouette characteristics associated with cardiac tamponade as a diagnostic method, and evaluate the safety and effectiveness of fluoroscopy-guided pericardiocentesis during catheter ablation.

Methods All cases of acute cardiac tamponade that occurred in the cardiac catheterisation laboratory during radiofrequency catheter ablation from March 2004 to November of 2009 were reviewed retrospectively.

Results Of 1832 catheter ablation procedures performed during a 5-year period, 10 (0.55%) were complicated by cardiac tamponade. Fluoroscopic examination confirmed the diagnosis in all 10 patients and demonstrated effusions before hypotension In 4 patients. All patients were stabilised by fluoroscopy-guided pericardiocentesis with placement of an indwelling catheter and autologous transfusion. The time interval between recognition of cardiac tamponade and completion of pericardiocentesis was 6.0±1.8 min (range 3–9 min). The mean aspirated blood volume was 437 ml (range 110–1400 ml), and the mean autotransfused blood volume was 425 ml (range 100–1384 ml). Surgical repair of the cardiac perforation was needed in one patient. No procedure-related death occurred. The ablation procedures were resumed and succeeded in 3 patients after pericardiocentesis.

Conclusion A reduction in the excursion of cardiac silhouette on fluoroscopy is an early diagnostic sign of cardiac tamponade during radiofrequency ablation. Fluoroscopy-guided pericardiocentesis is a safe and effective management strategy for cardiac tamponade developed in the cardiac catheterisation laboratory.