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

Abstract Background Late-onset complications of left atrial appendage occlusion (LAAO) device procedure are anecdotal and there are no such complications reported in literature using Cardia Ultraseal (Cardia, Inc., Eagan, MN, USA). Case summary We report the case of a 74-year-old Caucasian man affected by paroxysmal atrial fibrillation with significant bleeding risk (familiar thrombocytopenia, macroscopic haematuria episodes during therapy with direct oral anticoagulants, HAS-BLED risk score: 4) and ischaemic risk as well (CHADSVASC score: 3). The patient was treated with LAAO device implantation for high bleeding risk. Subsequently, after 26 days from LAAO procedure, he was admitted to the emergency department for haematic cardiac tamponade. The patient was successfully treated with subxyphoidal pericardiocentesis in the acute phase, unfortunately cardiac arrest occurred during the transfer to the referral hospital for urgent cardiac surgery. Permanent neurological damage was reported and the patient died on day 28. Discussion LAAO late-onset complications are very rare and the case presented is the first case described of late-onset pericardial effusion and tamponade secondary to the Cardia Ultraseal LAAO device implantation. We present a revision of the literature regarding the occurrence of similar adverse events and discuss the hypothetical mechanism of this major complication.

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A CASE OF GIANT LEFT ATRIAL APPENDAGE WITH ATRIAL FIBRILLATION MASQUERADING AS SYMPTOMATIC PERICARDIAL EFFUSION

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)04044-4 ◽

2021 ◽

Vol 77 (18) ◽

pp. 2689

Author(s):

Christopher Ford ◽

Joseph M. O'Brien ◽

David Irvin ◽

Janice Chow ◽

Jaya Chandrasekhar

Keyword(s):

Atrial Fibrillation ◽

Pericardial Effusion ◽

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Appendage

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Left atrial appendage occlusion in chicken‐wing anatomies: Imaging assessment, procedural, and clinical outcomes of the “sandwich technique”

Catheterization and Cardiovascular Interventions ◽

10.1002/ccd.29546 ◽

2021 ◽

Author(s):

Xavier Freixa ◽

Apostolos Tzikas ◽

Adel Aminian ◽

Eduardo Flores‐Umanzor ◽

Ole De Backer ◽

...

Keyword(s):

Clinical Outcomes ◽

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Sandwich Technique ◽

Left Atrial Appendage Occlusion

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Double-blind, placebo-controlled randomised clinical trial to evaluate the effect of ASPIRIN discontinuation after left atrial appendage occlusion in atrial fibrillation: protocol of the ASPIRIN LAAO trial

BMJ Open ◽

10.1136/bmjopen-2020-044695 ◽

2021 ◽

Vol 11 (3) ◽

pp. e044695

Author(s):

Mu Chen ◽

Qunshan Wang ◽

Jian Sun ◽

Peng-Pai Zhang ◽

Wei Li ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Left Atrial Appendage ◽

Ethics Committee ◽

Aspirin Therapy ◽

Atrial Appendage ◽

Control Group ◽

Coronary Syndrome ◽

Left Atrial Appendage Occlusion ◽

Increased Risk

IntroductionIt is the common clinical practice to prescribe indefinite aspirin for patients with non-valvular atrial fibrillation (NVAF) post left atrial appendage occlusion (LAAO). However, aspirin as a primary prevention strategy for cardiovascular diseases has recently been challenged due to increased risk of bleeding. Therefore, aspirin discontinuation after LAAO in atrial fibrillation (ASPIRIN LAAO) trial is designed to assess the uncertainty about the risks and benefits of discontinuing aspirin therapy at 6 months postimplantation with a Watchman LAAO device in NVAF patients.Methods and analysisThe ASPIRIN LAAO study is a prospective, multicentre, randomised, double-blinded, placebo-controlled non-inferiority trial. Patients implanted with a Watchman device within 6 months prior to enrollment and without pre-existing conditions requiring long-term aspirin therapy according to current guidelines are eligible for participating the trial. Subjects will be randomised in a 1:1 allocation ratio to either the Aspirin group (aspirin 100 mg/day) or the control group (placebo) at 6 months postimplantation. A total of 1120 subjects will be enrolled from 12 investigational sites in China. The primary composite endpoint is stroke, systemic embolism, cardiovascular/unexplained death, major bleeding, acute coronary syndrome and coronary or periphery artery disease requiring revascularisation at 24 months. Follow-up visits are scheduled at 6 and 12 months and then every 12 months until 24 months after the last patient recruitment.Ethics and disseminationEthics approval was obtained from the Ethics Committee of Xinhua Hospital, Shanghai, China (reference number XHEC-C-2018-065-5). The protocol is also submitted and approved by the institutional Ethics Committee at each participating centre. Results are expected in 2024 and will be disseminated through peer-reviewed journals and presentations at national and international conferences.Trial registration numberNCT03821883.

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