Zhang Yan, Yang Jing, Liu Qian, Wu Jinglan, Yin Lei, Lv Jing, You Ling, Zhang Yanan, Wang Lianxia, Zhao Yanlei, Hou Qian, Jing Weilin, Xie Ruiqin
First Department of Cardiology, Hebei Institute of Cardiovascular Research, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China.
Second Department of Cardiac Ultrasound, Hebei Institute of Cardiovascular Research, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China.
J Clin Med. 2023 Feb 24;12(5):1824. doi: 10.3390/jcm12051824.
(1) Background: This study aimed to investigate the effect of an additional catheter ablation (CA) procedure on the risk of post-procedure adverse events during CA combined with left atrial appendage closure (LAAC). (2) Methods: From July 2017 to February 2022, data from 361 patients with atrial fibrillation who underwent LAAC at our center were analyzed retrospectively. The adverse events were compared between CA + LAAC and LAAC-only groups. (3) Results: The incidence of device-related thrombus (DRT) and embolic events was significantly lower in the CA + LAAC group than in the LAAC-only group ( = 0.01 and 0.04, respectively). A logistic regression analysis revealed that the combined procedure served as a protective factor for DRT (OR = 0.09; 95% confidence interval: 0.01-0.89; = 0.04). Based on a Cox regression analysis, the risk of embolism marginally increased in patients aged ≥65 years (HR = 7.49, 95% CI: 0.85-66.22 = 0.07), whereas the combined procedure was found to be a protective factor (HR = 0.25, 95% CI: 0.07-0.87 = 0.03). Further subgroup and interaction analyses revealed similar results. (4) Conclusions: The combined procedure may be associated with a lower rate of post-procedure DRT and embolization without a higher occurrence of other adverse events after LAAC. A risk-score-based prediction model was conducted, showing a good prediction performance.
（1）背景：本研究旨在探讨在导管消融（CA）联合左心耳封堵（LAAC）过程中，额外进行一次CA手术对术后不良事件风险的影响。（2）方法：回顾性分析2017年7月至2022年2月在本中心接受LAAC的361例房颤患者的数据。比较CA + LAAC组和单纯LAAC组的不良事件。（3）结果：CA + LAAC组与单纯LAAC组相比，器械相关血栓（DRT）和栓塞事件的发生率显著更低（分别为 = 0.01和0.04）。逻辑回归分析显示，联合手术是DRT的保护因素（OR = 0.09；95%置信区间：0.01 - 0.89； = 0.04）。基于Cox回归分析，≥65岁患者的栓塞风险略有增加（HR = 7.49，95% CI：0.85 - 66.22， = 0.07），而联合手术是保护因素（HR = 0.25，95% CI：0.07 - 0.87， = 0.03）。进一步的亚组分析和交互分析得出了相似结果。（4）结论：联合手术可能与术后较低的DRT和栓塞发生率相关，且LAAC后其他不良事件的发生率不会更高。构建了基于风险评分的预测模型，显示出良好的预测性能。
