Case Presentation: A 53 year old female originally underwent an ablation for atrial fibrillation with post procedure course pericardial effusion requiring drain placement for 3 days. Patient recovered from original effusion and was sent home with colchicine and aspirin.
She presented to our care on day 28 after procedure, one week after recent hospitalization. Patient had developed a fever to 38.5C at home, nonproductive cough, dyspnea on exertion, orthopnea, nausea and vomiting. She had presented to her cardiologist with these symptoms 2 days prior to admission and had echocardiogram showing plueral effusions which were confirmed by chest CT day prior to admission. On day of admission, patient had a leukocytosis to 13.1 and elevated ESR to 61. She did not have any pericardial effusions. She was admitted for a possible pneumonia, however bedside ultrasound in the emergency room showed no evidence of loculations. She was admitted with a working diagnosis of Dressler’s syndrome given her recent history.
Patient developed rapid atrial fibrillation and mild pericardial effusion on day 1 and was started on prednisone and a dilatiazem drip for treatment. By hospital day 2, day 31 post procedure, the pericardial effusion started to respond to steroid treatment and resolve. Patient converted to sinus rhythm and patient was switched to an oral rhythm control agent. Because patient continued to complain of dyspnea and orthopnea, she underwent a thoracentesis on hospital day 3 removing 1.2L of fluid. Pleural fluid was transudative by Light’s criteria (serum LDH 263, fluid LDH 129, ratio 0.49). Fluid studies were otherwise unremarkable.
Patient was discharged by hospital day 3 on a long taper of prednisone.
Discussion: Dressler syndrome is a form of post cardiac injury syndrome presenting with pleuritic chest pain, low grade fevers, and mild pericardial effusions. The provoking cardiac injury varies, including cardiac surgery, pacemaker lead insertion, myocardial necrosis and now more recently radiofrequency ablation. Incidence post-MI Dressler syndrome has decreased to <5% in the era of percutaneous cardiac intervention however the incidence in post cardiac surgery still remains at 10-40%. Recently, this syndrome has been described in ablation for atrial fibrillation. With an increase incidence in ablative therapy, this is becoming of growing interest to hospitalists who assume care for this population as it becomes a more prevalent complication. The mechanism of injury remains poorly understood, but it is thought to be a result of antibodies after myocardial injury. Therapy is anti-inflammatory therapy and adjunctive colchicine.
Conclusions: Dressler syndrome is a diagnosis that needs to be considered for patient presenting after ablation for atrial fibrillation. Symptoms include chest pain, low grade fevers, ESR elevations, pericardial effusions and pleural effusions. Prompt diagnosis of this syndrome is essential as the treatment is simple with anti-inflammatory drugs such as steroids and colchicine.