Delayed pericardial effusion after left atrial appendage closure with
the LAmbre device: importance of a fully open umbrella
Abstract
Introduction: We aimed to investigate whether a modified implantation
method facilitating a fully open umbrella can reduce the pericardial
effusion/pericardial tamponade (PE/PT) rate after left atrial appendage
closure (LAAC) with the LAmbre device compared with the conventional
method (CM) in patients with non-valvular atrial fibrillation (NVAF).
Methods and results: Patients with NVAF who received either isolated
LAAC or combined catheter ablation and LAAC using the LAmbre device at
the First Affiliated Hospital of Wenzhou Medical University from January
2018 to December 2019 were enrolled. CM was used for device implantation
in the initial 59 patients, while a modified method (MM) was used in the
remaining 165 patients. Successful implantation was achieved in 98.3%
of patients in the CM group and in 98.8% in the MM group. A higher rate
of a fully open umbrella (98.8% vs 69%, P<0.001), less
requirement for recapture (46% vs 62.1%, P=0.036), and a lower
incidence of delayed PE/PT (1.2% vs 8.6%, P=0.005) were found in the
MM group compared with in the CM group. All of the five delayed PT
events occurred in patients with combined treatment. An umbrella that
was not fully open was the only factor associated with delayed PE/PT
events in a multivariable Cox model. Conclusions: LAAC with the LAmbre
device using an MM significantly increases the rate of a fully open
umbrella and decreases the requirement for recapture and the incidence
of delayed PE/PT. This method is more effective in patients with
combined treatment.