NYU School of Medicine, New York, NY, USA.
Eur Heart J Cardiovasc Imaging. 2012 Feb;13(2):132-8. doi: 10.1093/ejechocard/jer158. Epub 2011 Sep 8.
Atrial fibrillation is a common, clinically significant arrhythmic disorder that results in increased risk of morbidity and mortality in affected patients. Atrial fibrillation is more prevalent among men compared with women and the risk for developing atrial fibrillation increases with advancing age. Ischaemic stroke is the most common clinical manifestation of embolic events from atrial fibrillation. While anticoagulation treatment is the preferred treatment, unfortunately, many patients have contraindications for anticoagulation treatment making this option unavailable to them. Previous data have shown that most thrombi that form in association with non-valvular atrial fibrillation occur in the left atrial appendage (LAA). It has been suggested that isolating the LAA from the body of the left atrium might reduce the risk of embolic events and that LAA obliteration may be a treatment option for patients with atrial fibrillation who are not candidates for anticoagulation treatment. Several procedures have been developed for isolation of the LAA, including surgical procedures as well as catheter-based ones. In this paper, we will review the currently available techniques, emphasizing the catheter-based ones. We will examine the increasing role of real-time three-dimensional transoesophageal echocardiography for appropriate screening and patient selection for these procedures, intra-procedural guidance, and follow-up care.
心房颤动是一种常见的、具有临床意义的心律失常疾病，可使受影响患者的发病率和死亡率增加。与女性相比，男性更易患心房颤动，且随着年龄的增长，发生心房颤动的风险也会增加。缺血性脑卒中是心房颤动引起的栓塞事件的最常见临床表现。尽管抗凝治疗是首选治疗方法，但不幸的是，许多患者存在抗凝治疗的禁忌症，因此无法采用该治疗方法。先前的数据表明，与非瓣膜性心房颤动相关的大多数血栓形成发生在左心耳（LAA）。有人提出，将 LAA 与左心房的主体隔离开来可能会降低栓塞事件的风险，并且 LAA 闭塞可能是不适合抗凝治疗的心房颤动患者的一种治疗选择。已经开发出几种用于隔离 LAA 的程序，包括手术程序和基于导管的程序。在本文中，我们将回顾现有的技术，重点介绍基于导管的技术。我们将研究实时三维经食管超声心动图在这些程序的适当筛选和患者选择、术中指导和随访中的作用不断增加。
