Department of Cardiology, Xinhua Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
Clin Cardiol. 2023 Oct;46(10):1202-1209. doi: 10.1002/clc.24099. Epub 2023 Jul 31.
Catheter ablation (CA) combined with left atrial appendage occlusion (LAAO) is a feasible approach for atrial fibrillation (AF) patients. Its role in octogenarians with AF is unclear.
In AF patients over 80 years, CA combined with LAAO is a feasible way in restoring sinus rhythm and preventing stroke.
This is a single-center retrospective study. Patients who underwent CA and LAAO in a single procedure between March 2018 and December 2020 were included. Efficacy endpoints included procedural success rate, AF recurrence rate, and thromboembolic events. Safety endpoints included pericardial effusion/cardiac tamponade, device-related thrombus (DRT), all-cause death, and major bleeding.
Five hundred and five patients (mean age 69.5 ± 7.7 years; 230 [45.5%] female) were included, with 46 (9.1%) patients aged ≥80 years old (octogenarian group). Prevalence of paroxysmal AF (25 [54.3%] vs. 207 [45.1%], p < 0.001) and CHA2DS2VASc score (4.1 ± 1.3 vs. 3.1 ± 1.4, p < 0.0001) were higher in octogenarian patients. There were six cases (1.2%) of pericardial effusion (all in nonoctogenarian patients). At 3 months postprocedure, 437 patients underwent TEE/CT. Thirty-two (80%) octogenarian patients and 308 (77.6%) nonoctogenarian patients had no peri-device leak. After a mean follow-up of 26.9 ± 9.1 months, AF was documented in 10 (21.7%) patients in octogenarian group and in 103 (22.4%) patients in nonoctogenarian group (p = 0.99). The annual thromboembolic risk was 2.1% and 0.8% in the octogenarian group and nonoctogenarian group, respectively. Death occurred in 16 nonoctogenarian patients. One major bleeding was recorded in the octogenarian group.
The combination of CA and LAAO in a single procedure is a feasible treatment option in octogenarians with comparable efficacy and safety profile.
导管消融（CA）联合左心耳封堵（LAAO）是治疗心房颤动（AF）患者的一种可行方法。其在 80 岁以上 AF 患者中的作用尚不清楚。
在 80 岁以上的 AF 患者中，CA 联合 LAAO 是恢复窦性心律和预防中风的可行方法。
这是一项单中心回顾性研究。纳入 2018 年 3 月至 2020 年 12 月期间在单一手术中接受 CA 和 LAAO 的患者。疗效终点包括手术成功率、AF 复发率和血栓栓塞事件。安全性终点包括心包积液/心脏压塞、器械相关血栓形成（DRT）、全因死亡和大出血。
共纳入 505 例患者（平均年龄 69.5±7.7 岁；230[45.5%]例女性），其中 46 例（9.1%）患者年龄≥80 岁（高龄组）。阵发性 AF 的发生率（25[54.3%]例 vs. 207[45.1%]例，p<0.001）和 CHA2DS2VASc 评分（4.1±1.3 vs. 3.1±1.4，p<0.0001）均较高。高龄组有 6 例（1.2%）心包积液（均发生在非高龄组患者中）。术后 3 个月，437 例行 TEE/CT。32 例（80%）高龄患者和 308 例（77.6%）非高龄患者无器械周围漏。平均随访 26.9±9.1 个月后，高龄组 10 例（21.7%）和非高龄组 103 例（22.4%）患者记录到 AF（p=0.99）。高龄组和非高龄组的年血栓栓塞风险分别为 2.1%和 0.8%。16 例非高龄患者死亡。高龄组记录到 1 例大出血。
CA 联合 LAAO 单一手术在高龄患者中是一种可行的治疗选择，具有相当的疗效和安全性。
