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

Aims To evaluate factors influencing the length of stay in patients undergoing percutaneous left atrial appendage occlusion (LAAO). Methods and results Patient characteristics, procedural data and the occurrence of serious adverse events were analyzed from the AmplatzerTM AmuletTM Occluder Observational Study. Patients were divided into three groups: same day (S, 0day, n = 60, 5.6%) early (E, 1day, n = 526, 48.9%), regular (R, 2-3days, n = 338, 31.4%) and late (L, ≥4days, n = 152, 14.1%) discharge and followed up for 60 days. Procedure and device related SAE during the in-hospital stay (S: 0.0% vs. E: 1.0% vs. R: 2.1% vs. L: 23%, p<0.0001) were a major trigger for a prolonged in-hospital stay. Of the 37 subjects in the late discharge group with an SAE prior to discharge, cardiac or bleeding complications were the most common underlying conditions, occurring in 26 subjects. Multinomial logistic analysis only identified HAS-BLED score as an independent influencing factor (p = 0.04) for a late discharge. After 60 days, mortality tended to be greatest in the late discharge group (S: 0.0% vs. E: 1.0% vs. R: 1.2% vs. L: 3.3%, p = 0.1066). Conclusion Over half of the subjects receiving an Amplatzer Amulet occluder were discharged within 1 day of the implant procedure. Serious adverse events were a major trigger for a late discharge after LAAO. Increased HAS-BLED score was associated with a prolonged in-hospital stay.

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Left atrial appendage occlusion with the Amplatzer™ Amulet™ device: full results of the prospective global observational study

European Heart Journal ◽

10.1093/eurheartj/ehaa169 ◽

2020 ◽

Vol 41 (30) ◽

pp. 2894-2901 ◽

Cited By ~ 15

Author(s):

David Hildick-Smith ◽

Ulf Landmesser ◽

A John Camm ◽

Hans-Christoph Diener ◽

Vince Paul ◽

...

Keyword(s):

Adverse Events ◽

Ischaemic Stroke ◽

Major Bleeding ◽

Left Atrial ◽

Left Atrial Appendage ◽

Cardiovascular Death ◽

Atrial Appendage ◽

Stroke Rate ◽

Left Atrial Appendage Occlusion

Abstract Aims To evaluate the safety and efficacy of left atrial appendage occlusion (LAAO) with the Amplatzer™ Amulet™ occluder. Methods and results Patients with atrial fibrillation eligible for LAAO were recruited to a prospective global study. Implant procedures were undertaken with echocardiographic guidance. Transoesophageal echocardiography (TOE) was undertaken 1–3 months post-LAAO. Implant and follow-up TOEs were evaluated by a CoreLab. The primary endpoint was a composite of ischaemic stroke and cardiovascular death at 2 years. Serious adverse events were adjudicated by an independent clinical events committee. A total of 1088 patients were enrolled, aged 75.2 ± 8.5 years; 64.5% were male. CHA2DS2-VASc and HAS-BLED scores were 4.2 ± 1.6 and 3.3 ± 1.1, respectively. A total of 71.7% had prior major bleeding, and 82.8% had contraindications to oral anticoagulants. Implant success was 99.1%. Major adverse events (≤7 days post-procedure) occurred in 4.0%, including death (0.3%), stroke (0.4%), major vascular (1.3%), and device embolization (0.2%). A total of 80.2% of patients were discharged on antiplatelet therapy alone. Peridevice flow was <3 mm in 98.4% at follow-up TOE. Device-related thrombus (DRT) was seen in 1.6% of cases. Cardiovascular death or ischaemic stroke occurred in 8.7% of patients at 2 years. The ischaemic stroke rate was 2.2%/year—a 67% reduction compared to the CHA2DS2-VASc predicted rate. Major bleeding (Bleeding Academic Research Consortium type ≥ 3) occurred at rates of 10.1%/year (year 1) and 4.0%/year (year 2). Conclusion Following LAAO with the Amplatzer Amulet device, the ischaemic stroke rate was reduced by 67% compared to the predicted risk. Closure was complete in 98.4% of cases and DRT seen in only 1.6%.

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22-04: The impact of underlying heart rhythm on the incidence of pericardial effusion after left atrial appendage occlusion using Watchman – Data from the EWOLUTION registry

EP Europace ◽

10.1093/europace/18.suppl_1.i26a ◽

2016 ◽

Vol 18 (suppl_1) ◽

pp. i26-i26

Author(s):

Boris Schmidt ◽

Timothy Betts ◽

Horst Sievert ◽

Martin Bergmann ◽

Stephan Kische ◽

...

Keyword(s):

Pericardial Effusion ◽

Left Atrial ◽

Left Atrial Appendage ◽

Heart Rhythm ◽

Atrial Appendage ◽

Left Atrial Appendage Occlusion ◽

The Impact

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B-PO05-209 PERICARDIAL EFFUSION AFTER LEFT ATRIAL APPENDAGE OCCLUSION RESULTING FROM AN AORTIC DISSECTION

Heart Rhythm ◽

10.1016/j.hrthm.2021.06.1128 ◽

2021 ◽

Vol 18 (8) ◽

pp. S457

Author(s):

Kara Stout ◽

Andrew Goldsweig

Keyword(s):

Pericardial Effusion ◽

Aortic Dissection ◽

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Left Atrial Appendage Occlusion

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Anesthetic Management of Patients Undergoing Percutaneous Endocardial and Epicardial Left Atrial Appendage Occlusion

Seminars in Cardiothoracic and Vascular Anesthesia ◽

10.1177/1089253217714581 ◽

2017 ◽

Vol 21 (4) ◽

pp. 291-301 ◽

Cited By ~ 3

Author(s):

Zeena Husain ◽

Payam Safavi-Naeini ◽

Abdi Rasekh ◽

Mehdi Razavi ◽

Charles D. Collard ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Left Atrial ◽

Left Atrial Appendage ◽

Anesthetic Management ◽

The United States ◽

Atrial Appendage ◽

Thromboembolic Events ◽

Left Atrial Appendage Occlusion ◽

Antiarrhythmic Medications

Atrial fibrillation is the most common cardiac arrhythmia in adults affecting almost 6 million adults in the United States. The 2 most common comorbidities associated with atrial fibrillation are heart failure and thromboembolic events. Heart failure symptoms may be treated with rate control, antiarrhythmic medications or by catheter ablation. Unfortunately, despite optimal medical management, thromboembolic events still occur. Recently, there has been a great deal of interest and innovation in finding an alternative to chronic anticoagulation. Several percutaneous left atrial appendage occlusion devices have been developed over recent years, some of which have proven to be noninferior to anticoagulation in preventing strokes in atrial fibrillation patients. The 2 most widely used left atrial appendage occlusion devices are the WATCHMAN (Atritech Inc, Plymouth, MN, USA) and the LARIAT (SentreHEART, Palo Alto, CA, USA) devices. After a detailed description of the procedures, the anesthetic considerations of each procedure and management of specific adverse events are discussed within this review.

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