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. 2022 Jun 17;33(8):1747–1755. doi: 10.1111/jce.15590

Table 2.

Proposed classification system for the causes of cardiac tamponade during left atrial ablation, stratified by TSP culpability

Classification of cardiac tamponade Cause of tamponade Supporting evidence Incidence (n = 51)
TSP‐related (n = 35)
Type A Tamponade diagnosed following an attempted TSP with the needle or guidewire; no sheaths passed beyond the interatrial septum Repeated or challenging attempts at TSP; abnormal pressure trace obtained from TSP needle (e.g. suggestive of aortic or pericardial puncture) 10 (19.6%)
Type B Tamponade diagnosed following passage of the sheath(s) beyond the interatrial septum; no ablation performed Repeated or challenging attempts at TSP; difficult manipulation of the sheaths or mapping catheter; sheath or mapping catheter seen to pass outside the cardiac silhouette immediately following TSP; abnormal pressure trace obtained from sheath 19 (37.3%)
Type C Tamponade diagnosed immediately following withdrawal of sheaths on conclusion of the procedure Repeated or challenging attempts at TSP; haemodynamically stable on conclusion of ablation treatment, however sudden haemodynamic deterioration documented following sheath withdrawal 6 (11.8%)
Non‐TSP related (n = 16)
Type D Tamponade diagnosed during ablation treatment or during manipulation of the ablation catheter High force noted on ablation catheter; clear temporal association between the onset of ablation treatment and haemodynamic deterioration; haemodynamic deterioration whilst ablation catheter within the left atrium; visualization of ablation catheter outside of the cardiac silhouette or left atrial geometry during treatment phase 13 (25.5%)
Type E Tamponade diagnosed during ablation in association with a steam pop Impedance spike noted during ablation; audible ‘pop’ noted by operator 2 (3.9%)
Type F Tamponade diagnosed during recovery from procedure Haemodynamically stable following withdrawal of sheaths, but subsequent subacute deterioration documented during recovery 1 (1.9%)

Abbreviation: TSP, transseptal puncture.