Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Clinical Unit of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
Kardiol Pol. 2013;71(1):8-16.
Ischaemic stroke is a common complication of atrial fibrillation (AF). Cardiology societies recommend assessing the risk of ischaemic stroke and using adequate prevention in patients with AF. Currently, oral anticoagulants and antiplatelet drugs are the most commonly used methods of stroke prevention. Left atrial appendage (LAA) is thought to be the main source of thrombi in patients with AF. LAA closure procedures that have been recently introduced into the clinical practice are an alternative method of stroke prevention in patients with contraindications to oral anticoagulants or with a high risk of bleeding. Two systems of percutaneous LAA closure are currently available, the Watchman plug and the Amplatzer Cardiac Plug, but experience with these procedures is still very limited.
To provide early results regarding safety and feasibility of percutaneous LAA closure with the Amplatzer Cardiac Plug in patients with AF and multiple comorbidities resulting in a high risk of stroke and bleeding complications.
Twenty one patients with AF, at least 2 points in the CHADS2/CHA2DS2VASc score and a high risk of bleeding as assessed by the HAS-BLED score (at least 3 points) underwent percutaneous Amplatzer Cardiac Plug implantation. Patients with less than 3 points in the HAS-BLED score were also included in the study if they had contraindications to oral anticoagulants (e.g. previous haemorrhage, recurrent bleeding, epidermolysis) or suffered from recurrent ischaemic stroke despite anticoagulant treatment. The Amplatzer Cardiac Plug was implanted using the standard technique under fluoroscopic and echocardiographic guidance.
Percutaneous LAA closure with the Amplatzer Cardiac Plug was performed in a group of patients with many comorbidities who had a high risk of ischaemic stroke (CHA2DS2VASc score 4.43 ± 1.4 points) as well as a high risk of bleeding (HAS-BLED score 3.0 ± 0.7 points). LAA occlusion was successfully performed in 20 (95.2%) patients. A serious periprocedural complication (cardiac tamponade requiring pericardiocentesis) occurred in 1 (4.76%) patient.
Successful LAA occlusion is feasible in a vast majority of patients undergoing this procedure. The rate of serious periprocedural complications is relatively low. LAA occlusion is justified in a group of patients with a high risk of ischaemic stroke and a high risk of bleeding or contraindications to oral anticoagulants.
缺血性中风是心房颤动（AF）的常见并发症。心脏病学会建议评估患有 AF 患者发生缺血性中风的风险，并使用适当的预防措施。目前，口服抗凝剂和抗血小板药物是预防中风最常用的方法。左心耳（LAA）被认为是 AF 患者血栓的主要来源。最近引入临床实践的 LAA 闭合术是口服抗凝剂禁忌或出血风险高的患者预防中风的另一种方法。目前有两种经皮 LAA 闭合系统，即 Watchman 塞和 Amplatzer 心脏塞，但这些手术的经验仍然非常有限。
提供经皮 Amplatzer 心脏塞治疗 AF 合并多种合并症患者的安全性和可行性的早期结果，这些合并症导致中风和出血并发症的风险较高。
21 名 AF 患者，CHADS2/CHA2DS2VASc 评分至少 2 分，HAS-BLED 评分（至少 3 分）评估出血风险高，接受经皮 Amplatzer 心脏塞植入术。HAS-BLED 评分低于 3 分的患者，如果有口服抗凝剂的禁忌（例如，既往出血、复发性出血、表皮松解）或尽管接受抗凝治疗仍发生复发性缺血性中风，也包括在研究中。Amplatzer 心脏塞采用标准技术，在透视和超声心动图引导下植入。
在一组合并症多、中风风险高（CHA2DS2VASc 评分 4.43 ± 1.4 分）和出血风险高（HAS-BLED 评分 3.0 ± 0.7 分）的患者中，经皮 LAA 闭合术采用 Amplatzer 心脏塞成功进行。20 例（95.2%）患者成功进行 LAA 闭塞。1 例（4.76%）患者发生严重围手术期并发症（需要心包穿刺的心包填塞）。
在接受该手术的绝大多数患者中，成功进行 LAA 闭塞是可行的。严重围手术期并发症的发生率相对较低。在中风风险高、出血风险高或有口服抗凝剂禁忌的患者中，LAA 闭塞是合理的。
