Texas Cardiac Arrhythmia InstituteSt. David's Medical Center Austin TX.
Albert Einstein College of Medicine at Montefiore Hospital New York NY.
J Am Heart Assoc. 2021 May 4;10(9):e019664. doi: 10.1161/JAHA.120.019664. Epub 2021 Apr 19.
Background We compared the cognitive status and quality of life in patients with atrial fibrillation undergoing left atrial appendage occlusion (LAAO) or remaining on oral anticoagulation (OAC) after atrial fibrillation ablation. Methods and Results Cognition was assessed by the Montreal Cognitive Assessment (MoCA) survey at baseline and follow-up. Consecutive patients receiving LAAO or OAC after atrial fibrillation ablation were screened, and patients with a score of ≤17 were excluded from the study. Quality of life was measured at baseline and 1 year using the Atrial Fibrillation Effect on Quality of Life survey. A total of 50 patients (CHADS-VASc [congestive heart failure, hypertension, age≥75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65-74 years, sex category] score: 3.30±1.43) in the LAAO group and 48 (CHADS-VASc score 2.73±1.25) in the OAC group were included in this prospective study. Mean baseline MoCA score was 26.18 and 26.08 in the LAAO and OAC groups, respectively (=0.846). At 1 year, scores were 26.94 and 23.38 in the respective groups. MoCA score decreased by an estimated -2.74 (95% CI, -3.61 to -1.87; <0.0001) points in the OAC group, whereas the change in the LAAO group was nonsignificant (0.79; (95% CI, -0.06 to 1.64; =0.07). After adjusting for baseline clinical characteristics, remaining on OAC was an independent predictor of MoCA change at 1 year (regression coefficient, -3.38; 95% CI, -4.75 to -2.02; <0.0001). Change in Atrial Fibrillation Effect on Quality of Life score did not differ significantly in achieving a clinically important difference between groups. Conclusions In this series, a significant difference in the postprocedure MoCA score was observed in postablation patients with atrial fibrillation receiving LAAO versus remaining on OAC with a substantial decline in the score in the OAC group. However, quality of life improved similarly across groups. Registration https://www.ClinicalTrials.gov. Unique identifier: NCT01816308.
我们比较了接受左心耳封堵术（LAAO）或房颤消融术后继续口服抗凝治疗（OAC）的房颤患者的认知状态和生活质量。
在基线和随访时使用蒙特利尔认知评估（MoCA）量表评估认知功能。筛选接受房颤消融术后接受 LAAO 或 OAC 的连续患者，将得分≤17 的患者排除在研究之外。使用房颤对生活质量的影响调查（Atrial Fibrillation Effect on Quality of Life survey）在基线和 1 年时测量生活质量。共纳入 50 例 LAAO 组（CHADS-VASc[充血性心力衰竭、高血压、年龄≥75 岁、糖尿病、卒中和短暂性脑缺血发作、血管疾病、年龄 65-74 岁、性别类别]评分：3.30±1.43）和 48 例 OAC 组（CHADS-VASc 评分 2.73±1.25）的患者。LAAO 组和 OAC 组的平均基线 MoCA 评分为 26.18 和 26.08（=0.846）。在 1 年时，两组的 MoCA 评分分别为 26.94 和 23.38。OAC 组 MoCA 评分下降约 2.74 分（95%CI：-3.61 至-1.87；<0.0001），而 LAAO 组的变化无统计学意义（0.79；95%CI：-0.06 至 1.64；=0.07）。在校正基线临床特征后，OAC 治疗是 MoCA 评分在 1 年时改变的独立预测因子（回归系数，-3.38；95%CI：-4.75 至-2.02；<0.0001）。两组之间在实现重要临床差异的房颤对生活质量评分的变化无显著差异。
在本系列中，与房颤消融术后继续接受 OAC 治疗的患者相比，接受 LAAO 治疗的房颤消融术后患者的术后 MoCA 评分存在显著差异，OAC 组的评分显著下降。然而，两组的生活质量都有类似的改善。
