Güray Ümit, Korkmaz Ahmet, Gürsoy Havva Tuğba, Elalmış Özgül Uçar
Department of Cardiology, Ankara Numune Training and Research Hospital, Ankara, Turkey.
Eur Heart J Case Rep. 2019 Sep 1;3(3). doi: 10.1093/ehjcr/ytz124.
Atrial fibrillation (AF) is the most common cardiac arrhythmia and is a major cause of embolic stroke. In patients with hereditary bleeding disorders such as haemophilia, management of AF particularly anticoagulation can be quite challenging. Left atrial appendage (LAA) closure is an emerging option in AF patients who are not eligible for oral anticoagulation therapy because of contraindications or high bleeding risk.
A 67-year-old man with permanent AF and haemophilia was referred for further evaluation of our cardiology clinic by his primary haematologist. The CHA2DS2-VASc score was estimated to be 3 and the HAS-BLED score was 3. Due to high risk of bleeding, we decided to perform percutaneous LAA closure instead of oral anticoagulation. Pre-procedural cardiac computerized tomography angiography and transoesophageal echocardiography were performed for measurements of LAA dimensions and exclude LAA thrombus. Percutaneous LAA occlusion was performed using a 28-mm AmplatzerTM AmuletTM device. The final result was excellent without significant residual leak, pericardial effusion, and embolic complication. Clopidogrel 75 mg/day and aspirin 81 mg/day for 1 month with adequate FVIII prophylaxis and then only aspirin 81 mg/day for 2 months were recommended. No antiplatelet was given after 3 months. The patient did not report any thrombotic or haemorrhagic adverse events and there were no complications related to implanted device after 1 year of follow-up.
In patients with hereditary bleeding disorders such as haemophilia, management of AF particularly anticoagulation can be quite challenging. In this report, we present a case of percutaneous LAA occlusion using AmplatzerTM AmuletTM device in a patient who has haemophilia and permanent AF. LAA closure has the potential to be more cost effective as compared to oral anticoagulation therapy due to lesser necessity of clotting factor infusion.
心房颤动（AF）是最常见的心律失常，是栓塞性中风的主要原因。在患有遗传性出血性疾病（如血友病）的患者中，房颤的管理尤其是抗凝治疗可能极具挑战性。对于因禁忌症或高出血风险而不符合口服抗凝治疗的房颤患者，左心耳（LAA）封堵是一种新兴的选择。
一名67岁患有永久性房颤和血友病的男性由其初级血液科医生转介至我们的心脏病诊所进行进一步评估。CHA2DS2-VASc评分估计为3分，HAS-BLED评分为3分。由于出血风险高，我们决定进行经皮LAA封堵而非口服抗凝治疗。术前进行心脏计算机断层血管造影和经食管超声心动图检查以测量LAA尺寸并排除LAA血栓。使用28毫米的AmplatzerTM AmuletTM装置进行经皮LAA封堵。最终结果良好，无明显残余漏血、心包积液和栓塞并发症。建议服用氯吡格雷75毫克/天和阿司匹林81毫克/天，持续1个月，并进行充分的FVIII预防，然后仅服用阿司匹林81毫克/天，持续2个月。3个月后不再给予抗血小板药物。患者未报告任何血栓形成或出血不良事件，随访1年后未出现与植入装置相关的并发症。
在患有遗传性出血性疾病（如血友病）的患者中，房颤的管理尤其是抗凝治疗可能极具挑战性。在本报告中，我们展示了一例使用AmplatzerTM AmuletTM装置对患有血友病和永久性房颤的患者进行经皮LAA封堵的病例。与口服抗凝治疗相比，LAA封堵可能更具成本效益，因为凝血因子输注的必要性较小。
