Matthew J Price1, Miguel Valderrábano2, Sarah Zimmerman3, Daniel J Friedman4, Saibal Kar5, Jeptha P Curtis3,6, Frederick A Masoudi7, James V Freeman3,6. 1. Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, CA (M.J.P.). 2. Division of Cardiac Electrophysiology, Houston Methodist Hospital, TX (M.V.). 3. Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.Z., J.P.C., J.V.F.). 4. Electrophysiology Section, Duke University Hospital, Durham, NC (D.J.F.). 5. Los Robles Regional Medical Center, Thousand Oaks, CA (S.K.). 6. Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (J.P.C., J.V.F.). 7. Ascension Health, St Louis, MO (F.A.M.).
Abstract
BACKGROUND: Pericardial effusion (PE) is a potential complication of transcatheter left atrial appendage occlusion. The objective of this study was to investigate the incidence, associated characteristics, and outcomes of PE following left atrial appendage occlusion. METHODS: Patients in the NCDR LAAO Registry who underwent a Watchman procedure between January 1, 2016 and December 31, 2019 were included. The primary outcome was in-hospital PE requiring intervention (percutaneous drainage or surgery). Odds ratios (ORs) were calculated for adverse event rates associated with PE. RESULTS: The study population consisted of 65 355 patients. The mean patient age was 76.2±8.1 years, and the mean CHA2DS2-VASc score was 4.6±1.5. PE occurred in 881 patients (1.35%). Clinical variables independently associated with PE included older age, female sex, left ventricular function, paroxysmal atrial fibrillation, prior bleeding, lower serum albumin, and preprocedural dual antiplatelet therapy; procedural variables included number of delivery sheaths used, sinus rhythm during the procedure, and moderate sedation rather than general anesthesia. PE was associated with increased 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). PE during the index hospitalization was associated with increased risk of death (OR, 3.52 [95% CI, 2.23-5.54]; P<0.0001) and the composite of death, stroke, or systemic embolism (OR, 3.42 [95% CI, 2.31-5.07]; P<0.0001) between discharge and 45-day follow-up. CONCLUSIONS: In-hospital PE during transcatheter left atrial appendage occlusion is infrequent but associated with a substantially higher risk of adverse events, including in-hospital and early postdischarge mortality. Strategies to minimize PE are critical to improve the risk-benefit ratio for this therapy.
BACKGROUND: Pericardial effusion (PE) is a potential complication of transcatheter left atrial appendage occlusion. The objective of this study was to investigate the incidence, associated characteristics, and outcomes of PE following left atrial appendage occlusion. METHODS: Patients in the NCDR LAAO Registry who underwent a Watchman procedure between January 1, 2016 and December 31, 2019 were included. The primary outcome was in-hospital PE requiring intervention (percutaneous drainage or surgery). Odds ratios (ORs) were calculated for adverse event rates associated with PE. RESULTS: The study population consisted of 65 355 patients. The mean patient age was 76.2±8.1 years, and the mean CHA2DS2-VASc score was 4.6±1.5. PE occurred in 881 patients (1.35%). Clinical variables independently associated with PE included older age, female sex, left ventricular function, paroxysmal atrial fibrillation, prior bleeding, lower serum albumin, and preprocedural dual antiplatelet therapy; procedural variables included number of delivery sheaths used, sinus rhythm during the procedure, and moderate sedation rather than general anesthesia. PE was associated with increased 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). PE during the index hospitalization was associated with increased risk of death (OR, 3.52 [95% CI, 2.23-5.54]; P<0.0001) and the composite of death, stroke, or systemic embolism (OR, 3.42 [95% CI, 2.31-5.07]; P<0.0001) between discharge and 45-day follow-up. CONCLUSIONS: In-hospital PE during transcatheter left atrial appendage occlusion is infrequent but associated with a substantially higher risk of adverse events, including in-hospital and early postdischarge mortality. Strategies to minimize PE are critical to improve the risk-benefit ratio for this therapy.
Authors: Apostolos Tzikas; David R Holmes; Sameer Gafoor; Carlos E Ruiz; Carina Blomström-Lundqvist; Hans-Christoph Diener; Riccardo Cappato; Saibal Kar; Randal J Lee; Robert A Byrne; Reda Ibrahim; Dhanunjaya Lakkireddy; Osama I Soliman; Michael Näbauer; Steffen Schneider; Johannes Brachman; Jeffrey L Saver; Klaus Tiemann; Horst Sievert; A John Camm; Thorsten Lewalter Journal: EuroIntervention Date: 2016-05-17 Impact factor: 6.534
Authors: Saibal Kar; Shephal K Doshi; Ashish Sadhu; Rodney Horton; Jose Osorio; Christopher Ellis; James Stone; Manish Shah; Srinivas R Dukkipati; Stuart Adler; Devi G Nair; Jamie Kim; Oussama Wazni; Mathew J Price; Federico M Asch; David R Holmes; Robert D Shipley; Nicole T Gordon; Dominic J Allocco; Vivek Y Reddy Journal: Circulation Date: 2021-04-06 Impact factor: 29.690
Authors: Roberto Galea; Federico De Marco; Nicolas Meneveau; Adel Aminian; Frédéric Anselme; Christoph Gräni; Adrian T Huber; Emmanuel Teiger; Xavier Iriart; Flora Babongo Bosombo; Dik Heg; Anna Franzone; Pascal Vranckx; Urs Fischer; Giovanni Pedrazzini; Francesco Bedogni; Lorenz Räber; Marco Valgimigli Journal: Circulation Date: 2021-11-06 Impact factor: 29.690
Authors: Douglas Darden; Thao Duong; Chengan Du; Muhammad Bilal Munir; Frederick T Han; Ryan Reeves; Jacqueline Saw; Emily P Zeitler; Sana M Al-Khatib; Andrea M Russo; Karl E Minges; Jeptha P Curtis; James V Freeman; Jonathan C Hsu Journal: JAMA Cardiol Date: 2021-11-01 Impact factor: 30.154
Authors: Boris Schmidt; Timothy R Betts; Horst Sievert; Martin W Bergmann; Stephan Kische; Evgeny Pokushalov; Thomas Schmitz; Felix Meincke; Patrizio Mazzone; Kenneth M Stein; Hüseyin Ince; Lucas V A Boersma Journal: J Cardiovasc Electrophysiol Date: 2018-05-21
Authors: Srinivas R Dukkipati; Saibal Kar; David R Holmes; Shephal K Doshi; Vijendra Swarup; Douglas N Gibson; Brijeshwar Maini; Nicole T Gordon; Michael L Main; Vivek Y Reddy Journal: Circulation Date: 2018-08-28 Impact factor: 29.690
Authors: David R Holmes; Saibal Kar; Matthew J Price; Brian Whisenant; Horst Sievert; Shephal K Doshi; Kenneth Huber; Vivek Y Reddy Journal: J Am Coll Cardiol Date: 2014-07-08 Impact factor: 24.094
Authors: David R Holmes; Vivek Y Reddy; Zoltan G Turi; Shephal K Doshi; Horst Sievert; Maurice Buchbinder; Christopher M Mullin; Peter Sick Journal: Lancet Date: 2009-08-15 Impact factor: 79.321
Authors: Dhanunjaya Lakkireddy; David Thaler; Christopher R Ellis; Vijendra Swarup; Lars Sondergaard; John Carroll; Michael R Gold; James Hermiller; Hans-Christoph Diener; Boris Schmidt; Lee MacDonald; Moussa Mansour; Brijeshwar Maini; Laura O'Brien; Stephan Windecker Journal: Circulation Date: 2021-08-30 Impact factor: 29.690