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

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Pericardial Effusion After Left Atrial Appendage Closure: Timing, Predictors, and Clinical Impact
JACC: Cardiovascular Interventions ( IF 11.7 ) Pub Date : 2024-05-22 , DOI: 10.1016/j.jcin.2024.01.310
Roberto Galea ₁ , Tommaso Bini ₁ , Juan Perich Krsnik ₁ , Mariama Touray ₁ , Fabrice Gil Temperli ₁ , Mohammad Kassar ₁ , Athanasios Papadis ₁ , Steffen Gloeckler ₂ , Nicolas Brugger ₁ , Raouf Madhkour ₁ , David Julian Seiffge ₃ , Laurent Roten ₁ , George C M Siontis ₁ , Dierik Heg ₄ , Stephan Windecker ₁ , Lorenz Räber ₁

Affiliation

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

中文翻译：

左心耳封堵后心包积液：时机、预测因素和临床影响

心包积液（PE）是最常见的严重左心耳封堵术（LAAC）并发症，但其机制、时间过程和预后影响尚不清楚。本研究旨在评估 LAAC 后 PE 的频率、时间、预测因素和临床影响。前瞻性收集 2009 年至 2022 年间连续接受经皮 LAAC 患者的数据，包括 1 年随访。使用单（Watchman 2.5/FLX，Boston Scientific）和双（Amplatzer 心脏塞或护身符，St. Jude Medical/Abbott）LAAC 装置。影像核心实验室对 PE 进行判定，并将其分为早期（≤7 天）和晚期（8-365 天）。使用逻辑回归分析来确定早期和整体 PE 的预测因素。在 1,023 例尝试 LAAC 手术中，44 例 (4.3%) 患者观察到 PE； 34 名 (3.3%) 患者的 PE 被归类为早期，10 名 (0.9%) 患者的 PE 被归类为晚期。大多数 PE 发生在 LAAC 后 6 小时内 (n = 25, 56.8%)，并且具有临床相关性 (n = 28, 63.6%)。早期 PE 的独立预测因素是双封左心耳装置（调整后 OR：8.20；95% CI：1.09-61.69）、女性（调整后 OR：3.41；95% CI：1.50-7.73）、口服抗凝药物的使用基线时的 OAC（调整后 OR：2.60；95% CI：1.11-6.09）和高龄（调整后 OR：1.07；95% CI：1.01-1.23），而基线时的女性和 OAC 仍然是总体的独立预测因素体育。在这个大型 LAAC 登记中，20 名患者中观察到 PE 的比例<1，并且通常发生在手术后 6 小时内。大多数早期 PE 与临床相关，发生在 Amplatzer 心脏栓/护身符手术中。独立预测因素包括双闭合装置的使用、女性、基线 OAC 和高龄。（LAAC 注册：超声心动图引导左心耳封堵后的临床结果；）

更新日期：2024-05-22

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