Pericardial Tamponade After Left Atrial Appendage Occlusion Placement: A Case for Emergent Point-of-Care Ultrasound

TL;DR

A patient developed pericardial tamponade after a heart procedure, and point-of-care ultrasound helped diagnose and treat it quickly.

Contribution

Highlights the critical role of POCUS in diagnosing LAAO-related pericardial tamponade in emergency settings.

Findings

POCUS identified pericardial effusion and tamponade physiology in a post-LAAO patient.

Emergency pericardiocentesis led to rapid clinical improvement and successful recovery.

Nonspecific symptoms of tamponade emphasize the need for POCUS in timely diagnosis.

Abstract

The prevalence of atrial fibrillation (AF) is rising, with left atrial appendage occlusion (LAAO) devices emerging as viable alternatives to anticoagulation for stroke prevention in high-risk patients. Although LAAO devices reduce bleeding risks compared to traditional anticoagulants, they carry procedural risks, including pericardial effusion and tamponade.

We present a case of a 70-year-old male with a history of AF who presented to the emergency department with shortness of breath, dizziness, and weight gain five days post-LAAO placement. Point-of-care ultrasound (POCUS) revealed a large pericardial effusion with tamponade physiology. Emergency pericardiocentesis drained 800 mL of fluid, resulting in rapid clinical improvement. The patient’s recovery was uneventful, and he was discharged two days later.

Pericardial effusion and tamponade are serious complications of LAAO devices, often presenting with nonspecific symptoms. Emergency physicians should be familiar with the procedure itself, its complications, and the utility of POCUS in expediting care as seen in this case.

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