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BACKGROUND With the number of complex catheter ablation procedures increasing , procedure-related acute cardiac tamponade is encountered more frequently in the cardiac catheterization laboratory.Survival depends on prompt recognition and rescue pericardiocentesis.OBJECTIVE The aim of this report was to validate fluoroscopic heart silhouette characteristics associated with cardiac tamponade as a diagnostic method, and evaluate the safety and effectiveness of fluoroscopy-guided pericardiocentesis during catheter ablation.