Pericardial Effusion After Left Atrial Appendage Closure: Timing, Predictors, and Clinical Impact

JACC Cardiovasc Interv. 2024 Jun 10;17(11):1295-1307. doi: 10.1016/j.jcin.2024.01.310. Epub 2024 May 22.

Abstract

Background: Pericardial effusion (PE) is the most common serious left atrial appendage closure (LAAC) complication, but its mechanisms, time course, and prognostic impact are poorly understood.

Objectives: This study sought to assess the frequency, timing, predictors and clinical impact of PE after LAAC.

Methods: Data on consecutive patients undergoing percutaneous LAAC between 2009 and 2022 were prospectively collected including the 1-year follow-up. Both single (Watchman 2.5/FLX, Boston Scientific) and double (Amplatzer Cardiac Plug or Amulet, St. Jude Medical/Abbott) 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: Of 1,023 attempted LAAC procedures, PE was observed in 44 (4.3%) patients; PE was categorized as early in 34 (3.3%) and late in 10 (0.9%) patients. The majority of PEs 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 left atrial appendage devices (adjusted OR: 8.20; 95% CI: 1.09-61.69), female sex (adjusted OR: 3.41; 95% CI: 1.50-7.73), the use of oral anticoagulation (OAC) at baseline (adjusted OR: 2.60; 95% CI: 1.11-6.09), and advanced age (adjusted OR: 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 procedure. The majority of early PEs were clinically relevant and occurred in the Amplatzer Cardiac Plug/Amulet procedures. Independent predictors included the use of double-closure devices, female sex, OAC at baseline, and advanced age. (LAAC-registry: Clinical Outcome After Echocardiography-guided LAA-closure; NCT04628078).

Keywords: early pericardial effusion; late pericardial effusion; left atrial appendage closure; predictors; timing.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anticoagulants / administration & dosage
  • Anticoagulants / adverse effects
  • Anticoagulants / therapeutic use
  • Atrial Appendage* / diagnostic imaging
  • Atrial Appendage* / physiopathology
  • Atrial Fibrillation* / complications
  • Atrial Fibrillation* / diagnosis
  • Atrial Fibrillation* / physiopathology
  • Atrial Fibrillation* / therapy
  • Cardiac Catheterization* / adverse effects
  • Cardiac Catheterization* / instrumentation
  • Female
  • Humans
  • Left Atrial Appendage Closure
  • Male
  • Middle Aged
  • Pericardial Effusion* / diagnostic imaging
  • Pericardial Effusion* / etiology
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Septal Occluder Device
  • Sex Factors
  • Time Factors
  • Treatment Outcome

Substances

  • Anticoagulants

Associated data

  • ClinicalTrials.gov/NCT04628078