Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy.
Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy.
Heart Rhythm. 2019 Sep;16(9):1320-1326. doi: 10.1016/j.hrthm.2019.03.022. Epub 2019 Mar 27.
The combined left atrial appendage closure (LAAC) and cryoenergy pulmonary vein isolation (PVI) procedure has been proven safe and effective in managing stroke in patients with nonvalvular atrial fibrillation (AF), although most data refer to procedures performed using radiofrequency as the main energy source.
The purpose of this study was to evaluate long-term follow-up of patients with AF undergoing concomitant LAAC and cryoenergy PVI.
Patients undergoing LAAC and cryoballoon PVI at our institution were enrolled. At 3, 6, and 24 months from the index procedure, we determined the atrial arrhythmia recurrence rate, the extent of LAAC, and the rate of cerebrovascular/bleeding events.
Forty-nine patients (mean age 69 ± 8 years; 32/49 (67%) men; CHADS-VASc score 2.8 ± 1.2; HAS-BLED score 3 ± 1) with a guideline-recommended LAAC indication were included. Acute PVI and complete LAAC were achieved in 100% of patients. All patients completed at least 24 months of follow-up. At 8 weeks and 6 months, complete or satisfactory (<5 mm leak) LAAC rates were achieved in 40 (82%) and 9 (18%) and in 42 (86%) and 7 (14%) of patients, respectively. The overall freedom from atrial arrhythmia rate at 24 months was 29 (60%), and 45 (92%) of patients were off antithrombotic drugs. The observed annualized stroke and bleeding rates were 1% and 2%, respectively, a 71% and 60% risk reduction in comparison to event rates predicted from CHADS-VASc and HAS-BLED scores.
Concomitant cryoballoon ablation and LAAC procedures appear safe and effective at long-term follow-up, with high antithrombotic drug withdrawal rates at 24 months.
联合左心耳封堵（LAAC）和冷冻能量肺静脉隔离（PVI）术已被证明在管理非瓣膜性心房颤动（AF）患者的中风方面是安全有效的，尽管大多数数据是指使用射频作为主要能量源进行的手术。
本研究旨在评估同时进行 LAAC 和冷冻球囊 PVI 的 AF 患者的长期随访结果。
我们招募了在我院行 LAAC 和冷冻球囊 PVI 的患者。在指数手术后 3、6 和 24 个月，我们确定了房性心律失常复发率、LAAC 的范围以及脑血管/出血事件的发生率。
共纳入 49 例患者（平均年龄 69 ± 8 岁；32/49（67%）为男性；CHADS-VASc 评分 2.8 ± 1.2；HAS-BLED 评分 3 ± 1），均符合 LAAC 适应证指南。100%的患者实现了急性 PVI 和完全 LAAC。所有患者均完成了至少 24 个月的随访。在 8 周和 6 个月时，分别有 40（82%）和 9（18%）以及 42（86%）和 7（14%）的患者达到完全或满意（<5 毫米渗漏）的 LAAC 率。24 个月时的总体无房性心律失常率为 29（60%），45（92%）的患者停用抗血栓药物。观察到的年化卒中率和出血率分别为 1%和 2%，与 CHADS-VASc 和 HAS-BLED 评分预测的事件发生率相比，风险降低了 71%和 60%。
在长期随访中，冷冻球囊消融联合 LAAC 手术似乎是安全有效的，在 24 个月时抗血栓药物停药率较高。
