Intrapericardial triamcinolone for acute pericarditis after electrophysiologic procedures

Purpose. The use of intrapericardial triamcinolone for acute pericarditis after electrophysiologic procedures in three patients is described. Summary. Treatment for idiopathic pericarditis and viral pericarditis, which account for about 85% of cases, focuses on pain management and decreasing pericardial inflammation. This is oftentimes achieved with nonsteroidal antiinflammatory drugs (NSAIDs). Colchicine may be used in combination with NSAIDs, specifically in postmyocardial infarction pericarditis and recurrent pericarditis. Because oral corticosteroid use has been shown to be an independent risk factor in pericarditis recurrence, their use in patients with refractory pericarditis is reserved as a last-resort option. Intrapericardial triamcinolone is an uncommon treatment approach, although it is recommended in select situations of pericarditis according to guidelines developed by the European Society of Cardiology. In this retrospective case series, three patients with pericarditis, tamponade, or both as a complication of radiofrequency ablation or implantable cardioverter defibrillator implantation received triamcinolone. The drug was instilled intrapericardially, with doses ranging from 50 to 200 mg. In two patients, the need for pain medication and the perceived pain score decreased dramatically after triamcinolone administration. In the third patient, triamcinolone administration decreased the need for supportive therapy but was not deemed a complete clinical success. Additional study is necessary to better define the use of intrapericardial triamcinolone and determine long-term outcomes associated with this therapy. Other factors, including past medical history and renal function, also need to be taken into account when choosing the proper dosing regimen. Conclusion. Intrapericardial administration of triamcinolone acetonide may be an effective treatment for patients with acute pericarditis after electrophysiologic procedures.