title: Characterization of pleural effusion after left atrial appendage exclusion using the Lariat procedure.
abstract: BACKGROUND
  The Lariat procedure is increasingly used for the exclusion of the left atrial appendage (LAA) in atrial fibrillation (AF) patients. There are anecdotal reports of pleural effusions after the Lariat procedure. However, the incidence, demographics, and pathophysiology of these effusions are largely unknown.
  
  
  OBJECTIVE
  Characterization of pleural effusions in patients who underwent LAA exclusion using the Lariat procedure.
  
  
  METHODS
  We report the incidence, demographics, and clinical and laboratory characteristics of patients from a multicenter prospective registry who underwent the Lariat procedure and subsequently developed pleural effusions.
  
  
  RESULTS
  A total of 10 out of 310 (3.2%) patients developed significant pleural effusions after the Lariat procedure. The mean age of these patients was 67 ± 9, ranging from 52 to 78 years and included 5 (50%) males. Nine patients had persistent AF with median CHADS2 score of 2.7 ± 1.2. The LAA was successfully ligated in all these patients. Post-Lariat procedure, 6 patients developed bilateral and 4 patients developed left-sided pleural effusions. Pleural tap revealed transudative in 2 and exudative in 6 patients. The remaining 2 patients responded to active diuresis and behaved clinically like transudative effusions. There is a statistically significant difference between the onset of pleural effusion after the Lariat procedure between tPLE versus ePLE groups (14 ± 1.2 vs. 6 ± 6, P = 0.05).
  
  
  CONCLUSIONS
  Incidence of clinically significant pleural effusion is uncommon after the Lariat procedure and can be either exudative or transudative in nature depending on the underlying mechanisms. More prospective studies are needed to study the pathophysiologic basis of development of pleural effusions after the Lariat procedure.
authors.affiliation: Mid-America Cardiology and University of Kansas Medical Center, Kansas City, Kansas, USA.
authors.forename: Sampath
authors.initials: S
authors.lastname: Gunda
authors.affiliation: Mid-America Cardiology and University of Kansas Medical Center, Kansas City, Kansas, USA.
authors.forename: Arun
authors.initials: A
authors.lastname: Kanmanthareddy
authors.affiliation: Case Western Reserve University/Metrohealth Medical Center, Cleveland, Ohio, USA.
authors.forename: Ajay
authors.initials: A
authors.lastname: Vallakati
authors.affiliation: Mid-America Cardiology and University of Kansas Medical Center, Kansas City, Kansas, USA.
authors.forename: Pramod
authors.initials: P
authors.lastname: Janga
authors.affiliation: Mid-America Cardiology and University of Kansas Medical Center, Kansas City, Kansas, USA.
authors.forename: Muhammad Rizwan
authors.initials: MR
authors.lastname: Afzal
authors.affiliation: Mid-America Cardiology and University of Kansas Medical Center, Kansas City, Kansas, USA.
authors.forename: Jayasree
authors.initials: J
authors.lastname: Pillarisetti
authors.affiliation: Mid-America Cardiology and University of Kansas Medical Center, Kansas City, Kansas, USA.
authors.forename: Sudharani
authors.initials: S
authors.lastname: Bommana
authors.affiliation: Mid-America Cardiology and University of Kansas Medical Center, Kansas City, Kansas, USA.
authors.forename: Donita
authors.initials: D
authors.lastname: Atkins
authors.affiliation: Mid-America Cardiology and University of Kansas Medical Center, Kansas City, Kansas, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Earnest
authors.affiliation: Mid-America Cardiology and University of Kansas Medical Center, Kansas City, Kansas, USA.
authors.forename: Jayant
authors.initials: J
authors.lastname: Nath
authors.affiliation: Nebraska Heart Institute, Lincoln, Nebraska, USA.
authors.forename: Nagaraj
authors.initials: N
authors.lastname: Hosakote
authors.affiliation: Texas Cardiac Arrhythmia Institute, Austin, Texas, USA.
authors.forename: Luigi
authors.initials: L
authors.lastname: DI Biase
authors.affiliation: Texas Cardiac Arrhythmia Institute, Austin, Texas, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
authors.affiliation: Mid-America Cardiology and University of Kansas Medical Center, Kansas City, Kansas, USA.
authors.forename: Madhu
authors.initials: M
authors.lastname: Reddy
authors.affiliation: University of California, San Francisco, California, USA.
authors.forename: Randall
authors.initials: R
authors.lastname: Lee
authors.affiliation: Mid-America Cardiology and University of Kansas Medical Center, Kansas City, Kansas, USA.
authors.forename: Dhanunjaya
authors.initials: D
authors.lastname: Lakkireddy
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000503:physiopathology / Q000601:surgery*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005122:Exudates and Transudates; D005260:Female; D006801:Humans; D015994:Incidence; D008026:Ligation; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Lariat procedure; anticoagulation; atrial fibrillation; atrial natriuretic peptide; left atrial appendage; pleural effusions; stroke