A patient suffered from cardiac rupture and pericardial tamponade during atrial flutter ablation and then treated with emergent pericardiocentesis and thoracotomy for repairing the cardiac injury. Pericardial tamponadehas a high mortality. Tansesophageal echocardiography can be adopted to determine the volume of blood in the pericardium and the effect of hemostasis, as well as maintain circulation stability. Delayed abdominal hemorrhage after pericardial tamponade is rare which is usually missed diagnosed and misdiagnosed. Combined with transesophageal echocardiography and bedside ultrasonography, the secondary pericardial tamponade can be excluded as early as possible. It is of great significance for anesthesiologists and intensive care unit (ICU) doctors to master the ultrasonic monitoring technique.