Department of Cardiology, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK.
Department of Cardiology, Benha University, Benha, Egypt.
Heart. 2018 Apr;104(7):594-599. doi: 10.1136/heartjnl-2017-312383. Epub 2017 Nov 9.
Percutaneous left atrial appendage (LAA) occlusion can be an interventional alternative to oral anticoagulation for stroke prevention in patients with atrial fibrillation.
We delivered LAA occlusion therapy using a standardised approach to patient referral, multidisciplinary team assessment, implant criteria, imaging and follow-up. We analysed patient characteristics, efficacy and safety of the implant procedure, and 12-month outcomes.
Of 143 referrals from October 2014 to December 2016, 83 patients (age 76±8years, 32.5% female, mean CHADS-VASc score 4 ±1) were offered LAA occlusion. Eighty (95.3%) had previous major bleeding (intracranial in 59%). LAA occluder implantation with an Amulet device was successful in 82 (98.8%), with periprocedural major adverse events occurring in 5 (6.0%) patients (2 device embolisations including 1 death, 2 major bleeds). Cardiac imaging in 75 (94%) patients 2months following implant showed device-related thrombus in 1 case (1.3%) and minor (<5mm) device leaks in 13 (17.1%). Over a median 12-month follow-up, 3 (3.8%) ischaemic strokes, 2 (2.5%) haemorrhagic strokes and 5 (6.3%) major extracranial bleeds occurred. All-cause mortality was 10%, with most deaths (7, 87.5%) due to non-cardiovascular causes.
LAA occlusion may be a reasonable option for stroke prevention inhigh-risk patients with atrial fibrillation ineligible for anticoagulation. However, procedural complication rates are not insignificant, and patients remain at risk of serious adverse events and death even after successful implant.
经皮左心耳（LAA）封堵术可作为房颤患者预防卒中的一种替代口服抗凝的介入治疗方法。
我们采用标准化的患者转介、多学科团队评估、植入标准、影像学和随访方法来实施 LAA 封堵术治疗。我们分析了患者特征、植入程序的疗效和安全性以及 12 个月的结果。
在 2014 年 10 月至 2016 年 12 月期间，我们共收到 143 例患者的转介，其中 83 例（年龄 76±8 岁，32.5%为女性，平均 CHADS-VASc 评分为 4±1）接受了 LAA 封堵术。80 例（95.3%）有既往大出血史（颅内出血 59%）。82 例（98.8%）患者成功植入 Amulet 装置，5 例（6.0%）患者发生围手术期重大不良事件（2 例装置栓塞，包括 1 例死亡，2 例大出血）。75 例（94%）患者在植入后 2 个月进行心脏影像学检查，发现 1 例（1.3%）装置相关血栓形成和 13 例（17.1%）轻微（<5mm）装置漏。中位随访 12 个月期间，发生 3 例（3.8%）缺血性卒中和 2 例（2.5%）出血性卒中和 5 例（6.3%）重大颅外出血。全因死亡率为 10%，其中大多数死亡（7 例，87.5%）是由于非心血管原因所致。
对于不适合抗凝治疗的高危房颤患者，LAA 封堵术可能是预防卒中的一种合理选择。然而，手术并发症发生率不容忽视，即使植入成功，患者仍有发生严重不良事件和死亡的风险。
