Delayed cardiac tamponade in atrial fibrillation patients with left atrial appendage closure

Abstract Background: We sought to investigate the relationship of delayed cardiac tamponade (CT) after left atrial appendage closure (LAAC) in patients with atrial fibrillation (AF) and identify the adjacent anatomical structures. Methods: This retrospective and cross‐sectional study enrolled AF patients with LAAC complicated by delayed CT with concurrent emergency pericardiocentesis drainage who were seen at Zhoupu Hospital affiliated with the Shanghai University of Medicine and Health Sciences from August 2016 to June 2021. The mean follow-up time was 16 ± 12 months, and clinical data, including the relationship between the left atrial appendage and pulmonary artery and the vein anatomy revealed left atrium computed tomography angiography (CTA) before and after LAAC, were retrospectively analyzed. Results: Thirteen patients (mean age, 72.1 ± 8.3 years; seven men) in whom delayed CT was treated by pericardiocentesis and drainage after LAAC, including six patients with LAAC simultaneous cryoablation, were enrolled. Eight LAAs were of the cauliflower type, and five were of the chicken wing type. The seal plate diameter of the lobe-and-disc devices was 29.5 ± 2.8 mm. Ten patients with cardiac computed tomography angiography images were reviewed: the occluder was attached to a pulmonary artery in eight patients, to the left superior pulmonary vein only in one patient, and to the pulmonary artery and left superior pulmonary vein in one patient. One patient died 2 days after LAAC, and other 12 patients had a good prognosis. Conclusions: The anatomic relationship of the left atrial appendage, pulmonary artery, and left superior pulmonary vein was related to delayed CT after LAAC; the larger occluder and its anchor hook structure facilitated the occurrence of delayed CT.