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Continuous Cardiac Stroke Volume Monitoring Leads to Early Detection of Cardiac Tamponade in the Percutaneous intracardiac Intervention

Abstract

Takahide Murasawa, Katsuhito Fujiu, Jun Yokota, Keigo Iwazaki, Hikaru Tanimoto, Susumu Miyazaki, Kazuo Asada, Kojima Toshiya, Yasushi Imai, Masahiko Sumitani and Issei Komuro

Background: Cardiac tamponade is one of the major complications which can result from catheter-based cardiac management, and if its detection or treatment is delayed, it can be fatal. Detecting cardiac tamponade in the earliest possible stages is crucial for preventing its development into a life threatening condition.

Methods and results: In this study, an internal blood pressure reading was conducted as part of catheter ablation, cardiac electro physiologic study, and bi-ventricular pacing treatments, and this blood pressure wave form was used along with a FloTrac system to produce a continuous estimate of cardiac output. These data were then retrospectively analyzed to determine whether the FloTrac cardiac output showed changes prior to the onset of declining blood pressure, which is the typical indicator used to diagnose cardiac tamponade. The study was conducted on 213 subjects who were undergoing catheter ablation, cardiac electrophysiologic study, and bi-ventricular pacing treatments. Out of this group, 4 (1.9%) were diagnosed with cardiac tamponade. The FloTrac data for all of these cardiac tamponade subjects showed a decline in stroke volume and cardiac output, with the onset of these changes coming an average of 15.5 ± 6.2 minutes and 8.7 ± 1.0 minutes respectively in advance of the onset of declining blood pressure measurements from the internal blood pressure readings.

Conclusion: Continuous cardiac output measurements can be used to detect cardiac tamponade at an earlier stage than continuous internal blood pressure readings, and this could enable accelerated treatment of these complications.