Infeld Margaret M, Silverman Daniel N, Lustgarten Daniel L
University of Vermont Medical Center, Burlington, VT, USA.
University of Vermont College of Medicine, Burlington, VT, USA.
J Innov Card Rhythm Manag. 2019 Jan 15;10(1):3486-3493. doi: 10.19102/icrm.2019.100107. eCollection 2019 Jan.
To date, left atrial appendage closure (LAAC) devices continue to be assessed as an intuitive alternative to oral anticoagulant therapy to prevent embolic complications in patients with atrial fibrillation. Concerns remain about the up-front risks associated with device implantation as well as device efficacy in preventing embolic events as compared with anticoagulation. Currently, LAAC devices serve as a potential alternative to long-term anticoagulation with the benefit of decreased bleeding risk but with less protection against ischemic events. An individualized risk-benefit analysis with regard to stroke possibility, bleeding likelihood with long-term anticoagulation, the risks of an invasive procedure, and the risks associated with having a lifelong intracardiac device should be performed to guide careful patient selection for this operation.
迄今为止，左心耳封堵（LAAC）装置仍在作为口服抗凝治疗的直观替代方案进行评估，以预防房颤患者的栓塞并发症。与抗凝治疗相比，人们仍对装置植入的前期风险以及装置预防栓塞事件的疗效存在担忧。目前，LAAC装置可作为长期抗凝的潜在替代方案，其益处是降低出血风险，但对缺血性事件的预防作用较弱。应针对中风可能性、长期抗凝的出血可能性、侵入性手术风险以及终身携带心内装置的相关风险进行个体化的风险效益分析，以指导对此手术进行谨慎的患者选择。
