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Pericardial Effusion After LA Appendage Closure
Quick Takes
- The current single-center, retrospective analysis of a predominantly male cohort evaluated the frequency, timing, and clinical relevance of post-LA appendage closure pericardial effusion (PE).
- Overall frequency of PE was 4.3%; the majority occurred early after the procedure (<6 hours) and were clinically relevant (64%). Independent predictors of early PE included female sex, use of double closure device systems (Amulet), use of oral anticoagulant, and advanced age.
- Risk of PE was higher using a double (Amulet or its previous iteration ACP) as compared to a single (Watchman 2.5/FLX) closure system device and was independently associated with an increased risk of early PE (4.4% vs. 0.4%; aOR, 8.20; 95% CI, 1.09-61.69).
Study Questions:
What are the frequency, timing, clinical impact, and predictors of pericardial effusion (PE) after left atrial appendage closure (LAAC)?
Methods:
Data on consecutive patients undergoing percutaneous LAAC between 2009 and 2022 were prospectively collected including 1-year follow-up. Both, single (Watchman 2.5/FLX) and double (Amplatzer Cardiac Plug [ACP]/Amulet) LAAC devices were used. An imaging core laboratory adjudicated the PEs and categorized them as early (≤7 days) and late (8-365 days). Logistic regression analysis was used to identify predictors of early and overall PE.
Results:
Out of 1,023 attempted LAAC procedures, PE was observed in 44 (4.3%) patients and was categorized as early in 34 (3.3%) and late in 10 (0.9%) patients. The majority of PE occurred within 6 hours after LAAC (n = 25, 56.8%) and were clinically relevant (n = 28, 63.6%). Independent predictors of early PE were double closure LAA devices (adjusted odds ratio [aOR], 8.20; 95% confidence interval [CI], 1.09-61.69), female sex (aOR, 3.41; 95% CI, 1.50-7.73), use of oral anticoagulation (OAC) at baseline (aOR, 2.60; 95% CI, 1.11-6.09), and advanced age (aOR, 1.07; 95% CI, 1.01-1.23), whereas female sex and OAC at baseline remained independent predictors of overall PE.
Conclusions:
In this large LAAC registry, PE was observed in <1 in 20 patients and usually occurred within 6 hours after the procedure. The majority of early PEs were clinically relevant and occurred in the ACP/Amulet procedures. Independent predictors included the use of double closure devices, female gender, OAC at baseline, and advanced age.
Perspective:
PE is a serious procedural complication after LAAC. The current single-center, retrospective analysis of a predominantly male cohort evaluated the frequency, timing, and clinical relevance of post-LAAC PE. Overall frequency of PE was 4.3% and the majority occurred early after the procedure (<6 hours) and were clinically relevant (64%). Independent predictors of early PE included female sex, use of double closure device systems (Amulet), use of OAC, and advanced age. The risk of PE was higher using double (Amulet or its previous iteration ACP) as compared to a single (Watchman 2.5/FLX) closure system device and was independently associated with an increased risk of early PE (4.4% vs. 0.4%; aOR, 8.20; 95% CI, 1.09-61.69). Clinically relevant PE, which occurred within 7 days, seldom required cardiac surgery (13.6%) or resulted in death (4.5%). Findings will need validation in a prospective cohort evaluating only current iterations of LAAC devices.
Clinical Topics: Pericardial Disease, Arrhythmias and Clinical EP, Invasive Cardiovascular Angiography and Intervention
Keywords: Atrial Appendage, Pericardial Effusion
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