Management of pericardial effusion with andexanet alfa during epicardial ventricular tachycardia ablation.

UNLABELLED: Andexanet alfa, a reversal agent for factor Xa inhibitors, is rarely used during catheter ablation procedures. We describe a case in which andexanet alfa was effective to manage hemorrhagic pericardial effusion during epicardial ablation for ventricular tachycardia. After the administration of andexanet alfa, the therapeutic range of activated clotting times was difficult to achieve despite heparin administration. The procedure was completed safely by focusing on epicardial targets with minimal endocardial manipulation. Specific consideration of anticoagulation strategies is required in patients with hemorrhagic complications during ablation procedure. LEARNING OBJECTIVE: This case presents the first reported use of andexanet alfa during catheter ablation for ventricular arrhythmias and emphasizes the importance of tailoring procedural strategies to each case, including consideration of the arrhythmogenic substrate location, to avoid thromboembolic complications.