Berte Benjamin, Jost Christine Attenhofer, Maurer Dominik, Fäh-Gunz Anja, Pillois Xavier, Naegeli Barbara, Pfyffer Monica, Sütsch Gabor, Scharf Christoph
Cardiovascular Center, Klinik Im Park, Zürich, Switzerland.
LIRYC Institute, CHU Bordeaux, Pessac, France.
J Cardiovasc Electrophysiol. 2017 Oct;28(10):1140-1150. doi: 10.1111/jce.13289. Epub 2017 Jul 26.
The use of left atrial appendage (LAA) occluders in atrial fibrillation is increasing. There are few data on the comparison between transesophageal echocardiography (TEE) and computed tomography (MDCT) assessing peridevice flow and outcome of electrical cardioversion (ECV) in these patients.
Single-center prospective registry from 2009 to 2015 including all LAA occluders to analyze success and complications during implantation and follow-up. Patients having ≥1 ECV were further analyzed. TEE was performed during implantation and at 6 weeks. In a subgroup of 77 patients, we compared MDCT with TEE at 6 weeks. Overall, 135 patients (69 ± 9 years; 70% male; CHA DS -VASc score: 3.6 ± 1.4; HAS-BLED score: 2.5 ± 0.6) received a LAA occluder (Watchman, n = 73; ACP-1, n = 59; Amulet, n = 3; PVI + LAA occluder, n = 91; and LAA occluder only, n = 44). Device implantation was successful in 131 (97%). Eight patients (5.9%) had major periprocedural complications (ischemic stroke/transient ischemic attacks, n = 4, tamponade, n = 2, device thrombosis, n = 2, Dressler syndrome, n = 1). The periprocedural complication rate was similar between concomitant procedure and LAA occluder only (8/91 vs. 5/44; P = 0.6). Twelve patients (9%) died (procedure-related, n = 2; 1%) during follow-up of 44 months (IQR: 43). MDCT (n = 77) at 6 weeks showed similar peridevice flow compared to TEE (TEE: 1.5 ± 1.9 mm vs. MDCT: 1.1 ± 2.2 mm, P = 0.25). Thromboembolic events occurred in 3 patients (CVA, n = 1; TIA, n = 2) during follow-up. In total, 41 ECV were performed in 26 patients (1.6 ± 0.9/patient), 13 months (IQR: 24) after implantation (<1 month: n = 8). No ECV-related clinical complications were observed.
LAA occlusion is feasible with an acceptable safety profile and few events during long-term follow-up. ECV after LAA occlusion is feasible. MDCT could help to evaluate peridevice flow.
心房颤动患者中左心耳封堵器的使用正在增加。关于经食管超声心动图（TEE）和计算机断层扫描（MDCT）在评估这些患者封堵器周围血流及电复律（ECV）结果方面的比较数据较少。
2009年至2015年的单中心前瞻性登记研究，纳入所有左心耳封堵器以分析植入及随访期间的成功率和并发症。对接受≥1次ECV的患者进行进一步分析。植入时及术后6周进行TEE检查。在77例患者的亚组中，我们在术后6周将MDCT与TEE进行了比较。总体而言，135例患者（69±9岁；70%为男性；CHA₂DS₂-VASc评分：3.6±1.4；HAS-BLED评分：2.5±0.6）接受了左心耳封堵器（Watchman，n = 73；ACP-1，n = 59；Amulet，n = 3；PVI + 左心耳封堵器，n = 91；仅左心耳封堵器，n = 44）。131例（97%）患者封堵器植入成功。8例患者（5.9%）发生主要围手术期并发症（缺血性卒中/短暂性脑缺血发作，n = 4，心包填塞，n = 2，封堵器血栓形成，n = 2，德雷斯勒综合征，n = 1）。同期手术组与仅行左心耳封堵器组的围手术期并发症发生率相似（8/91 vs. 5/44；P = 0.6）。12例患者（9%）在44个月（四分位间距：43）的随访期间死亡（与手术相关，n = 2；1%）。术后6周MDCT（n = 77）显示封堵器周围血流与TEE相似（TEE：1.5±1.9mm vs. MDCT：1.1±2.2mm，P = 0.25）。随访期间3例患者发生血栓栓塞事件（脑卒中共1例；短暂性脑缺血发作2例）。26例患者共进行了41次ECV（1.6±0.9次/患者），在植入后13个月（四分位间距：24）（<1个月：n = 8）。未观察到与ECV相关的临床并发症。
左心耳封堵术可行，安全性可接受，长期随访期间事件较少。左心耳封堵术后进行ECV是可行的。MDCT有助于评估封堵器周围血流。
