ABSTRACT
Background: Post-cardiac injury syndrome or Dressler syndrome, described as pericarditis with or without effusion, is often associated with myocardial infarction or a procedure in which the pericardium is disturbed. However, it may be provoked by a minor intervention, including radiofrequency ablation. Case: A 41 year-old male with paroxysmal atrial fibrillation (AF) and obstructive sleep apnea on CPAP presented with chest pain, palpitations, and dyspnea. He underwent cryoablation 1 month prior to presentation. He was febrile, tachycardic, and hypotensive. ECGs showed atrial flutter (Figure A) and AF with rapid ventricular response. Cardioversion was unsuccessful. Decision-making: Work-up included a negative COVID PCR. C-Reactive Protein was 311 mg/L (normal <10.0 mg/L). A CT chest showed bilateral pleural effusions and a pericardial effusion. Thoracentesis removed 850 mL of serous yellow fluid (exudative effusion). Transthoracic echo (TTE) revealed normal left ventricular function with a small pericardial effusion. Within 24 hours, the patient demonstrated tamponade physiology. Pericardiocentesis removed 400 cc of serosanguinous fluid.Cardiac MRI was concerning for myopericarditis (Figure B).Rate control for AF was difficult to achieve in the face of an inflammatory state. After several days of high-dose ibuprofen and colchicine, the patient started sotalol with conversion to normal sinus rhythm. Conclusion: Although rare, Dressler syndrome can be associated with minimally-invasive cardiac procedures, including cryoablation. [Formula presented]