Pericardial effusion requiring intervention in patients undergoing percutaneous left atrial appendage occlusion: Prevalence, predictors, and associated in-hospital adverse events from 17,700 procedures in the United States

Heart Rhythm. 2021 Sep;18(9):1508-1515. doi: 10.1016/j.hrthm.2021.05.017. Epub 2021 May 18.

Abstract

Background: Left atrial appendage occlusion has shown promise in mitigating the risk of stroke in selected patients with atrial fibrillation.

Objective: The purpose of this study was to determine the real-world prevalence and in-hospital outcomes in left atrial appendage occlusion (Watchman) recipients complicated by pericardial effusion requiring percutaneous drainage or open cardiac surgery-based intervention.

Methods: Data were derived from the National Inpatient Sample database from January 2015 to December 2017. The primary outcomes assessed were the prevalence of pericardial effusion requiring intervention and in-hospital outcomes including mortality, other major complications, hospital stay > 1 day, and hospitalization costs. Predictors of pericardial effusion requiring intervention were also analyzed.

Results: Pericardial effusion requiring intervention occurred in 220 total patients (1.24%). After multivariable adjustment, pericardial effusion requiring intervention was associated with in-hospital mortality (adjusted odds ratio [aOR] 511.6; 95% confidence interval [CI] 122-2145.3), other Watchman-related major complications (aOR 1.35; 95% CI 0.83-2.19), length of stay > 1 day (aOR 17.64; 95% CI 12.56-24.77), and hospitalization cost above the median of $24,327 (aOR 3.58; 95% CI 2.61-4.91). Independent patient predictors of pericardial effusion requiring intervention from the procedure included advanced age (aOR 1.029 per 1-year increase; 95% CI 1.009-1.05 per 1-year increase), higher CHA2DS2-VASc score (aOR 1.221 per 1-point increase; 95% CI 1.083-1.377 per 1-point increase), and obesity (aOR 2.033; 95% CI 1.464-2.823).

Conclusion: In a large, contemporary real-world cohort of Watchman recipients in US practice, the prevalence of pericardial effusion requiring intervention was 1.24%. Pericardial effusion requiring intervention was associated with several adverse events including increased in-hospital mortality, other major complications, prolonged hospital stay, and hospitalization costs.

Keywords: Complications; Mortality; National estimates; Pericardial effusion; Watchman.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Atrial Appendage / surgery*
  • Atrial Fibrillation / complications*
  • Atrial Fibrillation / physiopathology
  • Atrial Fibrillation / surgery
  • Cardiac Catheterization / methods*
  • Cardiac Surgical Procedures / methods*
  • Female
  • Follow-Up Studies
  • Hospital Mortality / trends
  • Humans
  • Incidence
  • Length of Stay / trends
  • Male
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Pericardial Effusion / complications*
  • Pericardial Effusion / epidemiology
  • Pericardial Effusion / surgery
  • Prevalence
  • Retrospective Studies
  • Stroke / epidemiology
  • Stroke / etiology
  • Stroke / prevention & control*
  • United States / epidemiology