Incidence and related factors of pericardial tamponade after left atrial appendage closure in patients with non-valvular atrial fibrillation

Abstract

Objective To observe the incidence of pericardial tamponade (PT) after left atrial appendage closure (LAAC) in patients with non-valvular atrial fibrillation (NVAF), and to explore its related factors and outcomes. Methods NVAF patients who were hospitalized and treated with LAAC in Department of Cardiology of our hospital from August 2014 to March 2023 were selected for the study.The general clinical data, preoperative transthoracic echocardiography and transesophageal echocardiography data, results of routine preoperative laboratory tests, intraoperative data and follow-up data of the patients were collected through the hospital medical record management system.The enrolled patients were classified into the non-PT group (n=8) and the PT group (n=1 184) according to whether PT occurred after LAAC or not.The incidence of PT, related risk factors and outcomes were statistically analyzed. Results This study included 639 males (53.6%) and 553 females (46.4%), with an average age of 68.1±9.65 years.The CHA2DS2-VASc score was 4.51±1.72, and the HAS-BLED score was 3.36±1.09.PT occurred in 8 cases (0.67%), among them, 6 cases occurred 1 to 33 h after LAAC, and 2 cases occurred on day 19 and day 27 after LAAC.As for the results of transesophageal echocardiography (TEE) and LAA angiography, compared with the non-PT group, the PT group had the significantly larger maximum caliber of the LAA (P=0.025, P=0.015), smaller maximum depth of the LAA (P=0.028, P=0.031), and lower success rate of one-time placement of the occluder (P=0.031);The occluder compression rate of the PT group was significantly greater than that of the non-PT group (P=0.046).Multivariate analysis showed that larger maximum diameter of LAA, smaller average effective depth of LAA and larger compression rate of occluder were the main risk factors for PT.All the 8 PT patients were cured by stopping antithrombotic drugs, pericardiocentesis or surgical drainage.During a mean follow-up of 39±27 months, there were no device-related thrombosis (DRT), ischemic stroke, systemic embolism and other complications in the PT group. Conclusion The incidence of PT after LAAC is low, which is related to the large diameter of LAA, the relatively insufficient depth of the LAA and the large compression rate of the occlude.PT can be cured by stopping antithrombotic drugs and pericardiocentesis/surgical drainage.

Keywords

• atrial fibrillation
• left atrial appendage closure
• pericardial tamponade