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J Invasive Cardiol. 2020 Sep;32(9):358-362. doi: 10.25270/jic/20.00017. Epub 2020 Jun 8.
Left atrial appendage closure (LAAC) using the Watchman device has become a well-established, world-wide therapeutic alternative to oral anticoagulation in high-risk patients for bleeding with paroxysmal, persistent atrial fibrillation (Afib) or permanent Afib. Currently, in the United States, LAAC procedures are performed under general anesthesia (GA). We present the feasibility, effectiveness, and safety of LAAC under moderate conscious sedation (MCS).
A total of 112 patients with elevated CHA2DS22VASc (median score of 3) between November 2018 and November 2019 underwent transesophageal echocardiography (TEE)-guided LAAC with the FDA-approved Watchman LAAC device (Boston Scientific) under MCS. We prospectively evaluated clinical and procedural outcomes using medical records of these patients.
Mean patient age was 73.5 ± 4.5 years and 45 (40%) were women. Procedural duration, device implant time, and fluoroscopic times were 45 ± 8.6 minutes, 14.5 ± 2.8 minutes, and 10.2 ± 1.2 minutes, respectively. The median required dosage of propofol was 101 ± 2.8 mg. No complications were observed from MCS. There was no need for conversion to GA in any of the patients during the procedure.
LAAC is safe and effective when performed under MCS. Thus, applying MCS may simplify the LAAC procedure, as well as reduce procedural time and procedural costs, while increasing overall patient satisfaction.
左心耳封堵术（LAAC）使用 Watchman 装置已成为一种成熟的、全球范围内的治疗选择，适用于伴有阵发性、持续性心房颤动（Afib）或永久性 Afib 的高危出血风险患者，替代口服抗凝治疗。目前，在美国，LAAC 手术是在全身麻醉（GA）下进行的。我们报告了在中度镇静（MCS）下进行 LAAC 的可行性、有效性和安全性。
2018 年 11 月至 2019 年 11 月期间，共有 112 名 CHA2DS22VASc 评分较高（中位数为 3）的患者接受了经食管超声心动图（TEE）引导下的 LAAC 手术，使用经食品和药物管理局批准的 Watchman LAAC 装置（波士顿科学公司），并在 MCS 下进行。我们前瞻性地评估了这些患者的病历中的临床和程序结果。
患者平均年龄为 73.5 ± 4.5 岁，45 名（40%）为女性。手术持续时间、器械植入时间和透视时间分别为 45 ± 8.6 分钟、14.5 ± 2.8 分钟和 10.2 ± 1.2 分钟。异丙酚的中位所需剂量为 101 ± 2.8mg。MCS 无并发症。在手术过程中，没有患者需要转为 GA。
在 MCS 下进行 LAAC 是安全有效的。因此，应用 MCS 可能会简化 LAAC 手术程序，缩短手术时间和手术成本，同时提高患者整体满意度。
