Chen Mu, Sun Jian, Wang Qun-Shan, Zhang Peng-Pai, Li Wei, Zhang Rui, Mo Bin-Feng, Yu Yi-Chi, Cai Xingxing, Yang Mei, Lian Xiao-Ming, Zhao Yan, Gong Changqi, Yu Yi, Liu Bo, Feng Xiangfei, Lu Qiufen, Li Yi-Gang
Department of Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai 200092, China.
Department of Cardiology, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai 200092, China.
Int J Cardiol. 2022 Dec 1;368:41-48. doi: 10.1016/j.ijcard.2022.08.007. Epub 2022 Aug 8.
The combined procedure of catheter ablation and left atrial appendage closure (LAAC) aims to simultaneously control the heart rhythm and reduce the risk of strokes in patients with atrial fibrillation (AF). The study aims to evaluate the procedural safety and long-term outcome of the combined procedure in a large patient cohort.
Clinical data of AF patients who underwent the combined procedure was retrospectively analyzed. Procedural and imaging follow-up parameters were compared between the transesophageal echocardiography-guided standard process and fluoroscopy-guided modified process, and between the single-seal WATCHMAN and dual-seal LACBES devices. Long-term outcomes included all-cause mortality, thromboembolic events, major bleeding, and recurrence of atrial tachyarrhythmias.
A total of 1114 patients were included. The rates of procedure-related major complications were comparable between the standard and modified processes (3.7% vs. 2.2%, p = 0.219), except for a higher incidence of respiratory depression in standard process group (0.9% vs 0%, p = 0.037), and between WATCHMAN and LACBES devices (2.4% vs. 3.3%, p = 0.535). The follow-up imaging evaluation revealed a high rate of satisfactory seals (99.7%) and a low rate of device related thrombus (1.9%), which were similar between two process groups and devices. The follow-up of over 1960 patient-years revealed low rates of mortality, thromboembolism, and nonprocedural major bleeding (1.8, 3.2, and 0.9 per 100 patient-years, respectively). Recurrent atrial tachyarrhythmias was observed in 23.9% patients.
The results supported the safety and long-term efficacy of the combined procedure of catheter ablation and LAAC. Fluoroscopy-guided LAAC device implantation may be considered in experienced centers.
导管消融与左心耳封堵术（LAAC）联合治疗旨在同时控制房颤（AF）患者的心律并降低中风风险。本研究旨在评估该联合治疗在大型患者队列中的手术安全性和长期疗效。
回顾性分析接受联合治疗的房颤患者的临床资料。比较经食管超声心动图引导的标准流程与透视引导的改良流程之间，以及单密封的WATCHMAN装置和双密封的LACBES装置之间的手术及影像学随访参数。长期疗效指标包括全因死亡率、血栓栓塞事件、大出血和房性快速性心律失常复发。
共纳入1114例患者。标准流程与改良流程之间的手术相关主要并发症发生率相当（3.7%对2.2%，p = 0.219），但标准流程组呼吸抑制发生率较高（0.9%对0%，p = 0.037）；WATCHMAN装置与LACBES装置之间的手术相关主要并发症发生率也相当（2.4%对3.3%，p = 0.535）。随访影像学评估显示封堵成功率高（99.7%），器械相关血栓发生率低（1.9%），两个流程组和两种装置之间相似。超过1960患者年的随访显示死亡率、血栓栓塞和非手术大出血发生率低（分别为每100患者年1.8、3.2和0.9例）。23.9%的患者观察到房性快速性心律失常复发。
结果支持导管消融与LAAC联合治疗的安全性和长期疗效。在有经验的中心可考虑透视引导下植入LAAC装置。
