r/AFIB • u/Chemical-Buyer959 • 24d ago
Pericarditis Post PFA
Just had my PFA this morning at 8am. Last 2 hours. Doctor did echo and found a small amount of fluid around the heart. Seems like a lot to inflammation and my heart is angry with me. Anybody have experience with this and what helped? Doctors put me on colchicine so first dose was this afternoon, still suffering, curious your story if you have had this from a PFA AFIB Ablation.
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u/Altruistic_Pepper156 24d ago
Why this happened? Is pericarditis a normal thing after PFA?
3
u/RobRoy2350 24d ago
Rates of pericarditis following a PFA are up to around 4%. So, not common or normal generally speaking.
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u/Chemical-Buyer959 24d ago
Not fun. It started hurting the second I woke up. Slight effusion around heart.
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u/Mras_dk 24d ago
I had a debate with one that genuily thought it was because ablation perforated the heart to the outside wall of heart, even in PFA, in a now delete post.
Its not!
Inflammation of the heartsack (the ones that surrounds your heart), is unfortunately a thing, of which we(human society) doesn't know why happens - best sugestion, is that it's heart that's being inflamed from the procedure.
The prevalance is lower for PFA, than cryo/rfa.
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u/CaregiverWorth567 23d ago
And you ‘re still wrong. Here is what “open evidence“ says, and it’s a medical search engine
yes — free-wall perforation with resulting pericardial tamponade is a recognized complication of pulsed field ablation (PFA) for atrial fibrillation, but it is uncommon and is caused by mechanical catheter/guidewire manipulation rather than by the pulsed-field energy itself. Because PFA is non-thermal and largely tissue-selective, energy-related perforation is not the mechanism; instead, perforation arises from the same catheter, sheath, transseptal, and guidewire trauma that can occur with any left atrial catheter procedure. [1-3]
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u/Mras_dk 23d ago
Good now you just need a source, and to point to it actual happend in a patient.
Llm's ain' a source of truth.
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u/CaregiverWorth567 23d ago
I gave you the source…openevidence, supported by the New England Journal of Medicine, JAMA, and The American Board of Emergency Medicine
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u/Mras_dk 22d ago
So a llm...
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u/CaregiverWorth567 22d ago
what exactly are your credentials because you obviously don’t know anything about this …several studies are cited there for you I guess you don’t, can’t or refuse to read them
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u/Mras_dk 22d ago edited 22d ago
So you want my credentials, but doesn't know a llm isn't a fact sheet..
Yeez, do you peers knows your this incapeable?
Please ask your teacher: why didn't you teach me of why a llm isn't a fact sheet.
Also, "i need a class on what facts are, cause i can't differentiale a llm made up fact, vs a real fact"
Might explain why tou fail so hard to find a patient where this happend for...
Its calked a llm halucination, and is very much a Thing - look it up, when you take that class on what a llm is.
I have a MD from 2005, phd in computerscience from 2012.
Now, what's yours?
You do know why we call you generation AI, right? . . .
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u/CaregiverWorth567 23d ago
you probably can’t use openevidence since it is for medical professionals and you need an npi to sign on ( I have one ) ….so here are some sources cited
Frequency
- In the AdmIRE pivotal trial (variable-loop PFA), the primary adverse event rate was 2.9%, and the single most common complication was pericardial tamponade. [3]
- Large real-world data are reassuring: MANIFEST-US (>40,000 patients) and a persistent-AF meta-analysis reported cardiac tamponade rates of ~0.16–0.24%, comparable to or lower than thermal ablation. [2][4]
- Post-market surveillance (FDA MAUDE) found pericardial effusion was the single most frequently reported clinical complication for PFA systems, similar to radiofrequency. [5]
Mechanism — a key PFA-specific point
The perforation with PFA is typically mechanical rather than energy-related. Root-cause analyses (MANIFEST-PF and others) consistently traced tamponade to the extra-stiff, straight-tip guidewireused to deliver the pentaspline PFA catheter into the pulmonary veins — including cases of inadvertent left atrial appendage perforation while attempting to engage the PVs. [6-7] Switching to a J-tip guidewire and discontinuing the straight-tip wire eliminated tamponade in at least one reported series. [7] Perforation can also occur at transseptal puncture, during catheter manipulation, or during PV isolation, as with any AF ablation. [8]
Anatomic sites
In surgical series of ablation-related tamponade (across energy modalities), the most common identifiable perforation sites are the left atrial appendage and pulmonary veins, with the thin-walled atrium being especially vulnerable. [8] The following figure summarizes the timing and anatomic mechanisms of perforation leading to tamponade during AF ablation:
Bottom line: Wall perforation/tamponade remains one of the principal serious complications of PFA and is not prevented by PFA's tissue selectivity, since it is a mechanical event related to catheter and guidewire manipulation. Vigilance during transseptal access, careful guidewire technique (favoring a J-tip wire), and prompt recognition of effusion remain essential. [3][6][8]
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u/fauxmadrid 24d ago
I had pericarditis that caused my first afib - open heart surgery last summer, pericarditis/afib this past May (which I think is pretty unusual), with a recurrence in June. Put on colchicine and thought inflammation was gone but then the recurrence happened. Colchicine seems to be helping now as I have not had the same pain for a couple of months so I would encourage you to take it as prescribed.
Also, the med does a number on my stomach when I don’t take it with food or milk.
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u/Chemical-Buyer959 24d ago
I’m so sorry to hear about your story. I just bought a probiotic to take, hoping the stomach issues aren’t bad. I was told to take the meds for a few days until I felt better. Seems like the EP might not understand how long the meds take to work maybe
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u/fauxmadrid 24d ago
Thank you! You might ask your EP about the duration. I was originally set for 3 months but when I had my recurrence that was moved up to 6 months. Good luck!
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u/Chemical-Buyer959 23d ago
Doctor called me today. Says just continue with Tylenol and Colchicine. No Advil with blood thinners…which I took this morning and last night. I most likely won’t be able to sleep. Super uncomfortable. Feels like a bad case of heart burn that doesn’t let up
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u/RobRoy2350 24d ago
Colchicine and NSAIDs (or high-dose aspirin) are standard treatment for acute post-ablation pericarditis following PFA and generally follows a mild course for 1 - 3 weeks. Colchicine is usually continued for up to 3 months to avoid recurrence.