Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Curr Opin Cardiol. 2022 Jan 1;37(1):74-79. doi: 10.1097/HCO.0000000000000913.
Combined atrial fibrillation (AF) ablation and left atrial (LA) appendage (LAA) closure (LAAC) has been practiced for management of both the symptoms and the high stroke risk of AF. The purpose of this review is to review recent evidence regarding the combined procedure.
Newly acquired long-term data of combined AF ablation and LAAC supplied satisfactory evidence on the safety and efficacy of the combined procedure. Studies also showed LA structural remodeling following combined procedure was mainly affected by sinus rhythm status post catheter ablation, not by LAAC. A cost-effectiveness study revealed that combined procedure was a cost-effective therapeutic option in symptomatic AF patients with high stroke and bleeding risk. Due to recent evidence of high incidences of LAA thrombus formation after LAA electrical isolation (LAAEI) and benefit of LAAC after LAAEI, an extended combined procedure of standard AF ablation plus LAAEI and LAAC was considered as a potential therapeutic option for persistent AF patients with high stroke risk.
In conclusion, combined AF ablation and LAAC serve as a promising option for patients with symptomatic AF and high risk of stroke and/or bleeding.
合并心房颤动（AF）消融和左心房（LA）结扎（LAAC）已用于治疗 AF 的症状和高卒中风险。本综述的目的是回顾关于联合手术的最新证据。
新获得的合并 AF 消融和 LAAC 的长期数据为联合手术的安全性和疗效提供了令人满意的证据。研究还表明，联合手术后 LA 的结构重塑主要受消融术后窦律状态的影响，而不受 LAAC 的影响。一项成本效益研究表明，对于有高卒中风险和出血风险的症状性 AF 患者，联合手术是一种具有成本效益的治疗选择。由于最近有证据表明 LAAEI 后 LAA 内电隔离后 LAA 血栓形成的发生率较高，以及 LAAEI 后 LAAC 的益处，因此考虑将标准 AF 消融联合 LAAEI 和 LAAC 的扩展联合手术作为一种潜在的治疗选择，用于高卒中风险的持续性 AF 患者。
总之，合并 AF 消融和 LAAC 为有症状的 AF 且有高卒中风险和/或出血风险的患者提供了一种有前途的选择。
