Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands.
Department of Cardiology, AMC Amsterdam, Amsterdam, the Netherlands.
J Interv Card Electrophysiol. 2023 Dec;66(9):1971-1978. doi: 10.1007/s10840-023-01512-0. Epub 2023 Mar 1.
Left atrial appendage occlusion (LAAO) may be a viable option for stroke prevention in patients with non-valvular atrial fibrillation and a contraindication for oral anticoagulation. No evidence evaluating the safety of this procedure in patients with a cardiac implantable electronic device (CIED) exists. The aim of this study was to evaluate whether CIED function is affected by LAAO and to explore LAAO procedural characteristics and complications in patients with a CIED.
This single-center cohort study included consecutive patients scheduled for percutaneous LAAO. Patients with a CIED prior to LAAO were selected and compared to the patients without CIED, concerning procedural characteristics and peri-procedural complications. In the group of patients with CIEDs, essential pacemaker integrity parameters were compared before and after the procedure to detect possible micro and macro lead displacements.
Thirty-one patients with CIED were scheduled for LAAO (age 73.7 ± 5.4 years, 65% males, CHADS-VASc 4.3 ± 1.5, and HAS-BLED 3.3 ± 1.0). The 245 patients without CIED were younger, and HAS-BLED-score was slightly lower (69.4 ± 8.2 years, p < 0.001; 2.8 ± 1.0, p = 0.022). Patients without CIED more frequently underwent LAAO combined with catheter ablation (p = 0.002). All other procedural characteristics were comparable between both groups. No visible lead displacement was observed on chest X-ray after LAAO. Additionally, no differences in impedance, threshold, or intracardiac sensing in various CIED lead locations were found prior versus post LAAO.
This study supports the feasibility and safety of LAAO in patients with a CIED.
左心耳封堵术（LAAO）可能是一种可行的选择，用于预防非瓣膜性心房颤动且存在口服抗凝禁忌的患者发生中风。目前尚无评估该程序在心脏植入式电子设备（CIED）患者中的安全性的证据。本研究旨在评估 LAAO 是否会影响 CIED 功能，并探讨 CIED 患者 LAAO 的手术特点和并发症。
这是一项单中心队列研究，纳入了接受经皮 LAAO 的连续患者。选择 LAAO 前有 CIED 的患者，并与无 CIED 的患者进行比较，比较内容包括手术特点和围手术期并发症。在有 CIED 的患者组中，比较了手术前后基本起搏器完整性参数，以检测可能发生的微和宏观导联移位。
31 例有 CIED 的患者计划进行 LAAO（年龄 73.7±5.4 岁，65%为男性，CHA2DS2-VASc 评分为 4.3±1.5，HAS-BLED 评分为 3.3±1.0）。245 例无 CIED 的患者年龄较小，HAS-BLED 评分略低（69.4±8.2 岁，p<0.001；2.8±1.0，p=0.022）。无 CIED 的患者更常接受 LAAO 联合导管消融（p=0.002）。两组的其他手术特点无明显差异。LAAO 后胸部 X 线片未见明显导联移位。此外，在各种 CIED 导联位置，术前与术后的阻抗、阈值或心内感知均无差异。
本研究支持 LAAO 在 CIED 患者中的可行性和安全性。
