Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
Electrophysiology and Arrhythmia Services, Reid Health, Indiana University School of Medicine, Richmond, IN, 47374, USA.
Clin Interv Aging. 2021 Apr 19;16:655-663. doi: 10.2147/CIA.S296639. eCollection 2021.
LAAO has been an alternative therapy to oral anticoagulants (OACs) for stroke prophylaxis in patients with nonvalvular atrial fibrillation (NVAF) with elevated CHADS-Vasc score, but the long-term outcomes of LAAO and its impacts on cardiac electrical and mechanical remodeling remain to be learned. We aimed to describe the impact of left atrial appendage occlusion (LAAO) on atrial remodeling and cardiovascular outcomes within 5-year follow-up.
A total of 107 patients with nonvalvular atrial fibrillation (NVAF) undergoing LAAO in the Shanghai Tenth People's Hospital between January 2014 and July 2017 were included. All participants were followed for ECG, transthoracic echocardiography (TTE), and clinical outcomes (including cardiovascular death, heart failure, ischemic stroke/systemic embolism, and pericardial effusion) at 6 and 12 months, and thereafter every 12 months after LAAO discharge until 5 years.
After LAAO, the left atrial diameter significantly increased at 6 months (48.6 ± 6.7 vs 46.5 ± 7.0 mm); heart rate decreased immediately after the procedure (78.5 ± 14.7 vs 85.3 ± 21.7 bpm) when compared with the pre-procedure level. The QTc interval prolongated to the highest value of 460.7 ± 46.8 ms at 6 months (pre-procedure level of 433.7±49.0 ms). All these changes return to the pre-procedure level within the follow-up. For clinical outcomes, 51 patients suffered the composite of cardiovascular death (n=4, 3.7%), heart failure (n=25, 23.4%), ischemic stroke/systemic embolism (n=22, 20.6%), and pericardial effusion (n=26, 26.2%).
LAAO did not change ECG or TTE characteristics and nonprocedure-related pericardial effusion is common during long-term follow-up. Further studies are warranted to investigate the optimal time frame of anticoagulation in patients undergoing LAAO.
左心耳封堵术（LAAO）已成为非瓣膜性心房颤动（NVAF）伴高 CHADS-Vasc 评分患者卒中预防的替代疗法，但 LAAO 的长期结果及其对心脏电机械重构的影响仍有待研究。我们旨在描述左心耳封堵术（LAAO）对 5 年随访期间心房重构和心血管结局的影响。
2014 年 1 月至 2017 年 7 月期间，上海第十人民医院共纳入 107 例接受 LAAO 的 NVAF 患者。所有患者在 LAAO 出院后 6 个月和 12 个月以及此后每 12 个月进行心电图、经胸超声心动图（TTE）和临床结局（包括心血管死亡、心力衰竭、缺血性卒中和全身性栓塞以及心包积液）随访，直至 5 年。
LAAO 后，左心房直径在 6 个月时显著增加（48.6±6.7 比 46.5±7.0mm）；与术前相比，术后即刻心率下降（78.5±14.7 比 85.3±21.7bpm）。QTc 间期延长至 6 个月时的最高值 460.7±46.8ms（术前水平为 433.7±49.0ms）。所有这些变化在随访期间均恢复到术前水平。在临床结局方面，51 例患者发生心血管死亡（n=4，3.7%）、心力衰竭（n=25，23.4%）、缺血性卒中和全身性栓塞（n=22，20.6%）以及心包积液（n=26，26.2%）的复合结局。
LAAO 并未改变心电图或 TTE 特征，长期随访期间非手术相关的心包积液较为常见。需要进一步研究以探讨接受 LAAO 患者的最佳抗凝时间框架。
