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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
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Pericardial Effusion After Left Atrial Appendage Closure: Timing, Predictors, and Clinical Impact

Roberto Galea1, Tommaso Bini1, Juan Perich Krsnik1

  • 1Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.

JACC. Cardiovascular Interventions
|May 25, 2024
PubMed

Insights

Pericardial effusion (PE) after left atrial appendage closure (LAAC) occurs in less than 5% of patients, often within 6 hours. Double-closure devices, female sex, baseline oral anticoagulation, and older age predict PE risk.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Pericardial effusion (PE) is a significant complication of left atrial appendage closure (LAAC).
  • Understanding the mechanisms, timing, and impact of PE after LAAC is crucial for patient safety.
  • Current knowledge regarding PE post-LAAC is limited.

Purpose of the Study:

  • To determine the incidence, timing, and predictors of PE following LAAC.
  • To evaluate the clinical significance and prognostic impact of PE after LAAC.
  • To identify patient and procedural factors associated with PE development.

Main Methods:

  • Prospective data collection from LAAC procedures (2009-2022) with 1-year follow-up.
  • Inclusion of both single and double LAAC device types (e.g., Watchman, Amplatzer, Amulet).
  • Adjudication of PE by an imaging core laboratory, categorized as early (≤7 days) or late (8-365 days); logistic regression for predictor analysis.

Main Results:

  • PE occurred in 4.3% of 1,023 LAAC procedures, with 3.3% early and 0.9% late.
  • Most PEs (56.8%) occurred within 6 hours post-procedure; 63.6% were clinically relevant.
  • Independent predictors for early PE included double-closure devices (OR: 8.20), female sex (OR: 3.41), baseline oral anticoagulation (OR: 2.60), and advanced age (OR: 1.07).

Conclusions:

  • Pericardial effusion is an infrequent but significant complication of LAAC, typically occurring early.
  • Double-closure devices, female sex, baseline oral anticoagulation, and advanced age are key predictors of PE.
  • Early identification and management of PE are essential for improving outcomes after LAAC.
Abstract

Keywords:
early pericardial effusionlate pericardial effusionleft atrial appendage closurepredictorstiming

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