Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, CA (M.J.P.).
Division of Cardiac Electrophysiology, Houston Methodist Hospital, TX (M.V.).
Circ Cardiovasc Interv. 2022 May;15(5):e011718. doi: 10.1161/CIRCINTERVENTIONS.121.011718. Epub 2022 Apr 2.
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.
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.
The study population consisted of 65 355 patients. The mean patient age was 76.2±8.1 years, and the mean CHADS-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]; <0.0001), death (OR, 56.88 [95% CI, 39.79-81.32]; <0.0001), and the composite of death, stroke, or systemic embolism (OR, 28.64 [95% CI, 21.24-38.61]; <0.0001). PE during the index hospitalization was associated with increased risk of death (OR, 3.52 [95% CI, 2.23-5.54]; <0.0001) and the composite of death, stroke, or systemic embolism (OR, 3.42 [95% CI, 2.31-5.07]; <0.0001) between discharge and 45-day follow-up.
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.
心包积液（PE）是经导管左心耳封堵术的潜在并发症。本研究旨在探讨左心耳封堵术后 PE 的发生率、相关特征和结局。
纳入 2016 年 1 月 1 日至 2019 年 12 月 31 日期间在 NCDR LAAO 注册中心接受 Watchman 手术的患者。主要结局为需要介入治疗（经皮引流或手术）的住院期间 PE。计算了与 PE 相关的不良事件发生率的比值比（OR）。
研究人群包括 65355 例患者。患者平均年龄为 76.2±8.1 岁，平均 CHADS-VASc 评分为 4.6±1.5。881 例（1.35%）患者发生 PE。与 PE 相关的临床变量包括年龄较大、女性、左心室功能、阵发性心房颤动、既往出血、血清白蛋白水平较低以及术前双联抗血小板治疗；操作变量包括使用的输送鞘数量、手术期间的窦性心律以及中度镇静而非全身麻醉。PE 与住院期间中风（OR，6.58[95%CI，3.32-13.06]；<0.0001）、死亡（OR，56.88[95%CI，39.79-81.32]；<0.0001）和死亡、中风或全身性栓塞的复合终点（OR，28.64[95%CI，21.24-38.61]；<0.0001）的风险增加相关。索引住院期间发生的 PE 与出院后 45 天内死亡（OR，3.52[95%CI，2.23-5.54]；<0.0001）和死亡、中风或全身性栓塞的复合终点（OR，3.42[95%CI，2.31-5.07]；<0.0001）的风险增加相关。
经导管左心耳封堵术中住院期间发生的 PE 并不常见，但与不良事件风险显著增加相关，包括住院期间和出院后早期的死亡率。降低 PE 风险的策略对于改善该治疗的风险效益比至关重要。
