NCDR Study: Pericardial Effusion Following Transcatheter LAAO Found to Occur Infrequently, Associated With Higher Risk of Adverse Events

In-hospital pericardial effusion as a complication of transcatheter left atrial appendage occlusion (LAAO) was found to occur infrequently but was associated with a higher risk of adverse events, according to a study published in Circulation: Cardiovascular Interventions.

Matthew J. Price, MD, FACC, et al., looked at 65,355 patients (mean age 76.2±8.1, mean CHA2DS2-VASc score 4.6±1.5) captured by the NCDR LAAO Registry who underwent a transcatheter LAAO procedure using the first-generation Watchman device between Jan. 1, 2016 and Dec. 31, 2019. The primary outcome researchers evaluated was the incidence rate of in-hospital pericardial effusion requiring intervention via percutaneous drainage or surgery. Odds ratios (OR) for adverse events associated with pericardial effusion were additionally calculated.

Results showed that pericardial effusion occurred in 1.35% of patients, with clinical variables such as older age, female sex, left ventricular function, paroxysmal atrial fibrillation, prior bleeding, lower serum albumin and preprocedural dual antiplatelet therapy independently associated with the complication. Procedural variables associated with pericardial effusion included number of delivery sheaths used, sinus rhythm during the procedure and moderate sedation rather than general anesthesia.

When analyzing risk of adverse events, researchers found pericardial effusion was associated with greater risk of in-hospital stroke (OR, 6.58; 95% CI, 3.32-13.06; p<0.0001), death (OR, 56.88, 95% CI, 39.79-81.32; p<0.0001) and the composite of death, stroke or systemic embolism (OR, 28.64; 95% CI, 21.24-38.61; p<0.0001). Pericardial effusion during the index hospitalization was also associated with increased risk between discharge and 45-day follow-up for death (OR, 3.52; 95% CI, 2.23–5.54; p<0.0001) and the composite endpoint (OR, 3.42; 95% CI, 2.31-5.07; p<0.0001).

“Periprocedural [pericardial effusion] after transcatheter LAAO is infrequent but associated with substantially increased risk of adverse events, including stroke and both in-hospital and early post-discharge mortality,” state the study authors. “Strategies to minimize [pericardial effusion], potentially guided by an understanding of the associated patient and procedural risk factors, will be critical to improve the risk-benefit ratio for this therapy.”

Clinical Topics: Arrhythmias and Clinical EP, Pericardial Disease, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Albumins, Drainage, Registries, Embolism, Stroke, Atrial Fibrillation, Aftercare, Follow-Up Studies, Pericardial Effusion, Odds Ratio, Conscious Sedation, Patient Discharge, Incidence, LAAO Registry, National Cardiovascular Data Registries

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