Radiofrequency ablation (RFA), especially percutaneous RFA (PRFA), is a novel technique for the treatment of hepatocellular carcinoma (HCC) that is becoming increasingly more popular because of its feasibility, effectiveness, repeatability, and safety.1 The complications of PRFA mainly include pneumothorax, hemopneumothorax, visceral organ perforation, liver abscess, bile duct injury, intraperitoneal hemorrhage and tumor seeding.2,3 The prevalence of major complications was evaluated to be between 2.1%-6.0% and the mortality rate between 0.09%-0.50%.2,4,5 Acute hemorrhagic cardiac temponade (AHCT) is a life threatening and fatal condition, which however rarely complicated RFA procedure for HCC.6 Moumouh and his colleagues7 reported the first case of AHCT during PRFA procedure leading to death. Herein we described another severe case of PRFA induced AHCT, which was treated successfully.