Department of Cardiology, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany.
Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
Europace. 2020 Sep 1;22(9):1358-1366. doi: 10.1093/europace/euaa174.
Left atrial appendage (LAA) electrical isolation (LAAEI) in addition to pulmonary vein isolation is an emerging catheter-based therapy to treat symptomatic atrial fibrillation. Previous studies found high incidences of LAA thrombus formation after LAAEI. This study sought to analyse therapeutic strategies aiming at the resolution of LAA thrombi and prevention of thromboembolism.
Left atrial appendage electrical isolation was conducted via creation of left atrial linear lesions or cryoballoon ablation. Follow-up including transoesophageal echocardiography was conducted. In patients with LAA thrombus, oral anticoagulation (OAC) was adjusted until thrombus resolution was documented. Percutaneous LAA closure (LAAC) under use of a cerebral protection device was conducted in case of medically refractory LAA thrombi. Left atrial appendage thrombus was documented in 54 of 239 analysed patients who had undergone LAAEI. Thrombus resolution was documented in 39/51 patients (72.2%) with available follow-up after adjustment of OAC. Twenty-nine patients underwent LAAC and 10 patients were kept on OAC after LAAEI. No thromboembolic events or further LAA thrombi were documented after 553 ± 443 days of follow-up in these patients. Persistent LAA thrombi despite adaption of OAC was documented in 12/51 patients. One patient remained on OAC until the end of follow-up, while LAAC with a cerebral protection device was performed in 11 patients in the presence of LAA thrombus without complications.
Left atrial appendage thrombus formation is common after LAAEI. Adjustment of OAC leads to LAA thrombus resolution in most patients. Left atrial appendage closure in the presence of LAA thrombi might be a feasible option in case of failed medical treatment.
左心耳（LAA）电隔离（LAAEI）除肺静脉隔离外，也是一种新兴的导管治疗方法，用于治疗有症状的心房颤动。先前的研究发现 LAAEI 后 LAA 血栓形成的发生率较高。本研究旨在分析旨在解决 LAA 血栓和预防血栓栓塞的治疗策略。
通过创建左心房线性病变或冷冻球囊消融进行 LAA 电隔离。进行随访，包括经食管超声心动图检查。对于 LAA 血栓患者，调整口服抗凝剂（OAC），直至记录到血栓消退。对于药物难治性 LAA 血栓，在使用脑保护装置的情况下进行经皮 LAA 封堵（LAAC）。在 239 例接受 LAAEI 的患者中，有 54 例患者记录到 LAA 血栓。在可获得随访的 39/51 例患者（72.2%）中，OAC 调整后记录到血栓消退。29 例患者接受 LAAC，10 例患者在 LAAEI 后继续接受 OAC。在这些患者中，553±443 天的随访后，未记录到血栓栓塞事件或进一步的 LAA 血栓。尽管调整了 OAC，但仍有 12/51 例患者持续存在 LAA 血栓。1 例患者一直接受 OAC 治疗至随访结束，而在存在 LAA 血栓且无并发症的情况下，11 例患者使用脑保护装置进行 LAAC。
LAAEI 后 LAA 血栓形成较为常见。调整 OAC 可使大多数患者的 LAA 血栓消退。在药物治疗失败的情况下，LAA 血栓存在时进行 LAA 封堵可能是一种可行的选择。
