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Published on: February 26, 2013
Periprocedural Pericardial Effusion Complicating Transcatheter Left Atrial Appendage Occlusion: A Report From the
Matthew J Price1, Miguel Valderrábano2, Sarah Zimmerman3
1Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, CA (M.J.P.).
Insights
Pericardial effusion (PE) after left atrial appendage occlusion is uncommon but significantly increases the risk of death and stroke. Minimizing PE is crucial for improving patient outcomes and the safety of this procedure.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Technology
Background:
- Pericardial effusion (PE) is a recognized complication of transcatheter left atrial appendage occlusion (LAAO).
- Understanding the incidence, patient characteristics, and procedural factors associated with PE is essential for risk mitigation.
Purpose of the Study:
- To determine the incidence of in-hospital PE following LAAO.
- To identify clinical and procedural variables associated with PE.
- To evaluate the outcomes and risks associated with PE post-LAAO.
Main Methods:
- Analysis of patients undergoing the Watchman procedure from the NCDR LAAO Registry (2016-2019).
- In-hospital PE requiring intervention was the primary outcome.
- Odds ratios were calculated to assess adverse event rates linked to PE.
Main Results:
- The study included 65,355 patients; 1.35% experienced PE.
- Independent predictors of PE included older age, female sex, specific cardiac conditions, and procedural factors like sedation type and sheath usage.
- PE was significantly associated with increased in-hospital and early post-discharge risks of stroke, death, and composite adverse events.
Conclusions:
- In-hospital PE after transcatheter LAAO is infrequent but carries a substantially elevated risk of mortality and other adverse events.
- Developing strategies to minimize PE is critical for enhancing the risk-benefit profile of LAAO procedures.
Background:
Pericardial effusion (PE) is a potential complication of transcatheter left atrial appendage occlusion. The objective of this study was to investigate the incidence, associated characteristics, and outcomes of PE following left atrial appendage occlusion.
Methods:
Patients in the NCDR LAAO Registry who underwent a Watchman procedure between January 1, 2016 and December 31, 2019 were included. The primary outcome was in-hospital PE requiring intervention (percutaneous drainage or surgery). Odds ratios (ORs) were calculated for adverse event rates associated with PE.
Results:
The study population consisted of 65 355 patients. The mean patient age was 76.2±8.1 years, and the mean CHA2DS2-VASc score was 4.6±1.5. PE occurred in 881 patients (1.35%). Clinical variables independently associated with PE included older age, female sex, left ventricular function, paroxysmal atrial fibrillation, prior bleeding, lower serum albumin, and preprocedural dual antiplatelet therapy; procedural variables included number of delivery sheaths used, sinus rhythm during the procedure, and moderate sedation rather than general anesthesia. PE was associated with increased risk of in-hospital stroke (OR, 6.58 [95% CI, 3.32-13.06]; P<0.0001), death (OR, 56.88 [95% CI, 39.79-81.32]; P<0.0001), and the composite of death, stroke, or systemic embolism (OR, 28.64 [95% CI, 21.24-38.61]; P<0.0001). PE during the index hospitalization was associated with increased risk of death (OR, 3.52 [95% CI, 2.23-5.54]; P<0.0001) and the composite of death, stroke, or systemic embolism (OR, 3.42 [95% CI, 2.31-5.07]; P<0.0001) between discharge and 45-day follow-up.
Conclusions:
In-hospital PE during transcatheter left atrial appendage occlusion is infrequent but associated with a substantially higher risk of adverse events, including in-hospital and early postdischarge mortality. Strategies to minimize PE are critical to improve the risk-benefit ratio for this therapy.
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