NEW YORK (Reuters Health) – In patients with cardiac tamponade, extended drainage using a pericardial catheter versus simple pericardial drainage reduces the likelihood of recurrence, according to study findings by a Los Angeles-based team appearing in the American Journal of Cardiology online September 7.

“We found that the absence of extended drainage with a pericardial catheter, incomplete drainage of an effusion, the pericardial catheter drainage duration, loculated effusion, and malignancy were independent predictors of recurrent pericardial tamponade,” the authors report.

For their study, Dr. Robert J. Siegel, at Cedars-Sinai Heart Institute, and colleagues reviewed outcomes in 157 consecutive patients with cardiac tamponade that was treated by percutaneous pericardiocentesis.

Within this group, 123 then underwent extended catheter drainage: that is, “until the drainage was <100 ml for a 24-hour period, and a follow-up echocardiogram demonstrated the residual effusion to be noncircumferential and <1 cm in size.” The duration of catheter drainage ranged from 10 to 96 hours, mean 38 hours, the report indicates.

At 1-year follow-up, the overall recurrence rate of cardiac tamponade was 20%. However, the rate was only 12% among patients that had extended drainage compared with 52% in those who had simple pericardiocentesis, the investigators found.

On further analysis, factors identified as independently associated with recurrence included absence of extended drainage (hazard ratio 4.1; p =0.002), incomplete drainage (HR 9.7; p <0.001), loculated effusion (HR 11.1; p=0.001), and malignancy (HR 3.3; p=0.037).

“Malignancy is a common cause of large symptomatic pericardial effusion,” Dr. Siegel and colleagues point out.

“Catheter drainage,” they conclude, “can lead to improved quality of life by reducing the risk of recurrence and thus offer a less-invasive alternative to pericardiotomy in patients with malignant effusions.”

Reference:
Frequency of Recurrence of Pericardial Tamponade in Patients With Extended Versus Nonextended Pericardial Catheter Drainage
Am J Cardiol 2011.