Department of Cardiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Zhongshan Road No.321, Nanjing, 210000, China.
BMC Cardiovasc Disord. 2019 Jun 10;19(1):138. doi: 10.1186/s12872-019-1123-2.
Catheter ablation (CA) and left atrial appendage closure (LAAC) have been combined into a novel one-stop procedure for patients with atrial fibrillation (AF). However, postoperative complications are relatively common in patients undergoing LAAC; the complications, including residual flow, increase in the risk of bleeding, or other adverse events, are unknown in patients receiving one-stop therapy. Therefore, we tried to evaluate the adverse events of CA and LAAC hybrid therapy in patients with nonvalvular AF.
We performed a meta-analysis and computer-based literature search to identify publications listed in the PubMed, Embase, and Cochrane library databases. Studies were included if patients received CA and LAAC hybrid therapy and reported adverse events.
Overall 13 studies involving 952 patients were eligible based on the inclusion criteria. In the periprocedural period, the pooled incidence of pericardial effusion was 3.15%. The rates of bleeding events and residual flow were 5.02 and 9.11%, respectively. During follow-up, the rates of all-cause mortality, embolism events, bleeding events, AF recurrence, and residual flow were 2.15, 5.24, 6.95, 32.89, and 15.35%, respectively. The maximum occurrence probability of residual flow events was 21.87%. Bleeding events were more common in patients with a higher procedural residual flow event rate (P = 0.03). A higher AF recurrence rate indicated higher rates of embolism events (P = 0.04) and residual flow (P = 0.03) during follow-up.
Bleeding events were more common in patients with a higher procedural residual flow event rate. However, combined CA and LAAC therapy is reasonably safe and efficacious in patients with nonvalvular AF. Further studies on the safety and efficacy of CA or LAAC alone are necessary in future.
导管消融（CA）和左心耳封堵（LAAC）已结合为一种治疗心房颤动（AF）的新型一站式治疗方法。然而，LAAC 术后并发症在患者中较为常见；对于接受一站式治疗的患者，包括残余分流、增加出血风险或其他不良事件的并发症尚不清楚。因此，我们试图评估非瓣膜性 AF 患者中 CA 和 LAAC 联合治疗的不良事件。
我们进行了荟萃分析和基于计算机的文献检索，以确定在 PubMed、Embase 和 Cochrane 图书馆数据库中列出的出版物。如果患者接受 CA 和 LAAC 联合治疗并报告不良事件，则纳入研究。
根据纳入标准，共有 13 项研究，涉及 952 例患者符合条件。在围手术期，心包积液的总发生率为 3.15%。出血事件和残余分流的发生率分别为 5.02%和 9.11%。在随访期间，全因死亡率、栓塞事件、出血事件、AF 复发和残余分流的发生率分别为 2.15%、5.24%、6.95%、32.89%和 15.35%。残余分流事件的最大发生概率为 21.87%。出血事件在残余分流事件发生率较高的患者中更为常见（P=0.03）。AF 复发率较高提示栓塞事件（P=0.04）和随访期间残余分流（P=0.03）的发生率较高。
出血事件在残余分流事件发生率较高的患者中更为常见。然而，CA 和 LAAC 联合治疗在非瓣膜性 AF 患者中是合理安全且有效的。未来有必要对 CA 或 LAAC 单独治疗的安全性和有效性进行进一步研究。
