Yuniadi Yoga, Hanafy Dicky A, Raharjo Sunu B, Yugo Dony
Department of Cardiology and Vascular Medicine Faculty of Medicine Universitas Indonesia, and National Cardiovascular Center Harapan Kita Jakarta Indonesia.
J Arrhythm. 2019 Feb 4;35(2):262-266. doi: 10.1002/joa3.12151. eCollection 2019 Apr.
Left atrial appendage (LAA) closure device is an alternative to anticoagulants for stroke prevention in selected atrial fibrillation (AF) patients. The LAA device implantation is safe with short period of learning curve. The standard implantation technique warrants a transesophageal echocardiography (TEE) guided and general anesthesia. In region of Asia Pacific as well as Indonesia, both TEE and general anesthesia are not always available in district hospital. We studied the safety and efficacy of Amplatzer Cardiac Plug (ACP) implantation guided by fluoroscopy only and without general anesthesia.
Consecutive nonvalvular AF patients with CHADSVASc score of ≥2 and HASBLED score of ≥3 are participated. Patients requiring long-life anticoagulant for any other indication are excluded. The choice of implanted first or second-generation ACP is that with excess size of 2-4 mm of measured landing zone diameter.
Twenty-five subjects were implanted ACP by means fluoroscopy only (Group A) and 28 subjects using standard technique group (Group B). The median AF duration was 36 months (6-276 months) and majority of patients (49%) are having permanent AF. The mean CHA2DS2VASc score is 3.9 ± 1.63. Successful implantation of ACPs was 96% in both groups. Nonfatal pericardial effusion occurred in three patients. During 75 weeks of follow-up period, there were no significant differences of stroke event and death between groups.
ACP implantation guided with fluoroscopy only is feasible and safe.
左心耳封堵装置是某些心房颤动（AF）患者预防卒中的抗凝替代方案。左心耳装置植入安全，学习曲线短。标准植入技术需要经食管超声心动图（TEE）引导及全身麻醉。在亚太地区以及印度尼西亚，地区医院并非总能进行TEE检查及提供全身麻醉。我们研究了仅在透视引导下且无需全身麻醉植入Amplatzer心脏封堵器（ACP）的安全性和有效性。
纳入CHADSVASc评分≥2且HASBLED评分≥3的非瓣膜性AF连续患者。排除因任何其他指征需要长期抗凝治疗的患者。植入第一代或第二代ACP的选择依据是测量的着陆区直径超出2 - 4mm。
25名受试者仅通过透视植入ACP（A组），28名受试者采用标准技术（B组）。AF的中位持续时间为36个月（6 - 276个月），大多数患者（49%）为永久性AF。平均CHA2DS2VASc评分为3.9±1.63。两组中ACP的成功植入率均为96%。3例患者发生非致命性心包积液。在75周的随访期内，两组之间的卒中事件和死亡无显著差异。
仅在透视引导下植入ACP是可行且安全的。
