Alipour Arash, Swaans Martin J, van Dijk Vincent F, Balt Jippe C, Post Martijn C, Bosschaert Mike A R, Rensing Benno J, Reddy Vivek Y, Boersma Lucas V A
Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands.
Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands.
JACC Clin Electrophysiol. 2015 Dec;1(6):486-495. doi: 10.1016/j.jacep.2015.07.009. Epub 2015 Oct 22.
The study sought to determine long-term clinical effects of combining catheter ablation (CA) and left atrial appendage (LAA) occlusion (LAAO) in a single procedure.
CA relieves symptoms in atrial fibrillation (AF), but freedom from AF is not assured. Thus, oral anticoagulation (OAC) remains necessary in high stroke risk patients. LAAO has proved a viable alternative for preventing thromboembolic complications.
Symptomatic patients with drug-refractory AF (CHADS ≥1) and indications for LAAO were included. Transesophageal echocardiography was performed to assess LAA size/anatomy/thrombus. After CA, LAAO was performed using the Watchman device (Atritech, Inc., Plymouth, Minnesota, Minnesota). At 3 months, OAC was switched to aspirin/clopidogrel if LAAO criteria were met.
From September 2009 to October 2013, 62 patients (22 female, 64 ± 8 years of age, CHADS 2.5) underwent combined procedures. Indications for LAAO included history of stroke despite OAC (29.0%), contraindications for OAC (24.2%), high stroke risk (24.2%), and miscellaneous reasons (22.6%). LAAO resulted in complete acute closure in all, with a median number of 1 device. After a median follow-up of 38 (range: 25 to 45) months, 95% of the patients met the criteria for successful sealing and 78% could discontinue OAC, while recurrence of AF was documented in 42%. During long-term follow-up, 3 ischemic strokes were observed with an annual stroke risk of 1.7%, which is lower than the expected annual risk of 6.5%.
LAAO combined with CA for AF can be performed successfully and safely in a single procedure, with a lower than expected stroke rate. Further studies are necessary to determine which patients benefit most from the combined therapy.
本研究旨在确定在单一手术中联合导管消融（CA）与左心耳（LAA）封堵（LAAO）的长期临床效果。
CA可缓解房颤（AF）症状，但无法确保房颤不再复发。因此，对于高卒中风险患者，口服抗凝治疗（OAC）仍然必要。LAAO已被证明是预防血栓栓塞并发症的可行替代方法。
纳入有症状的药物难治性AF（CHADS≥1）且有LAAO指征的患者。行经食管超声心动图检查以评估LAA大小/解剖结构/血栓情况。CA术后，使用Watchman装置（Atritech公司，明尼苏达州普利茅斯）进行LAAO。3个月时，如果符合LAAO标准，则将OAC转换为阿司匹林/氯吡格雷。
2009年9月至2013年10月，62例患者（22例女性，年龄64±8岁，CHADS 2.5）接受了联合手术。LAAO的指征包括尽管接受OAC仍有卒中史（29.0%）、OAC禁忌证（24.2%）、高卒中风险（24.2%）和其他原因（22.6%）。LAAO使所有患者实现完全急性封堵，中位使用1个装置。中位随访38（范围：25至45）个月后，95%的患者符合成功封堵标准，78%患者可停用OAC，而AF复发率为42%。在长期随访中，观察到3例缺血性卒中，年卒中风险为1.7%，低于预期的6.5%年风险。
LAAO联合CA治疗AF可在单一手术中成功且安全地进行，卒中发生率低于预期。需要进一步研究以确定哪些患者从联合治疗中获益最大。
