联合左心耳封堵与导管消融治疗左房心律失常：一项真实世界、倾向评分匹配分析。
Combined left atrial appendage occlusion and catheter ablation procedure for left atrial arrhythmias: A real-world, propensity-matched analysis.
作者信息
Preisendörfer Stefan, Ayub Muhammad T, Sheth Aakash, Jabbour George Y, Singh Madhurmeet, Patel Chinmay P, Gada Hemal, Bhonsale Aditya, Dhande Mehak, Estes Nathan A, Kancharla Krishna, Kliner Dustin E, Makani Amber, Naniwadekar Aditi, Shalaby Alaa, Singla Virginia, Voigt Andrew, Saba Samir F, Jain Sandeep K
机构信息
Heart & Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
出版信息
J Cardiovasc Electrophysiol. 2024 Dec;35(12):2423-2431. doi: 10.1111/jce.16466. Epub 2024 Oct 15.
INTRODUCTION
Real-world studies comparing safety and efficacy of combined percutaneous left atrial appendage occlusion (LAAO) and catheter ablation (CA) to LAAO alone are limited.
METHODS
Patients from a large US hospital system undergoing combined LAAO and left-atrial CA from 8/2020 to 2/2024 were retrospectively analyzed and compared to a control group undergoing LAAO alone. Controls were identified using a 1:2 propensity score match based on LAAO device type (Watchman FLX vs. Amulet), CHAD-VASc and Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio [INR], Elderly, Drugs/alcohol (HAS-BLED) scores and compared for safety, sealing performance and clinical outcomes at 6 months.
RESULTS
Patients were younger in the combined (n = 72) than in the control group (n = 144, 70.2 ± 7.3 vs. 76.7 ± 6.9 years, p < 0.001) but otherwise comparable with a mean CHAD-VASc score of 4.2 ± 1.1 and 4.4 ± 1.2 (p = 0.26) and HAS-BLED score of 2.2 ± 0.8 and 2.3 ± 0.7 (p = 0.34). Successful LAAO implantation rates were the same (95.8% vs. 95.8%, p = 0.99) with longer procedure times seen in the combined group (156.5 ± 53 vs. 56 ± 26 min, p < 0.001). Both major (1.4% vs. 2.1%, p = 0.72) and minor (27.8% vs. 19.4%, p = 0.17) in-hospital complications were similar between the combined and control group, respectively. At 45 days, presence of peri-device leak (18.3% vs. 30.4%, p = 0.07) and device related thrombosis (4.5% vs. 4.5%, p = 0.96) on transesophageal echocardiogram did not differ. Finally, all-cause mortality (0% vs. 1.4%, p = 0.99), thromboembolic (0% vs. 0%, p = 0.99) and bleeding (6.1% vs. 4.4%, p = 0.73) events during follow-up were comparable.
CONCLUSION
This large, real-world analysis indicates comparable safety and efficiency of combined LAAO and CA when compared with LAAO alone.
引言
比较经皮左心耳封堵术（LAAO）联合导管消融术（CA）与单纯LAAO安全性和有效性的真实世界研究有限。
方法
回顾性分析2020年8月至2024年2月在美国一家大型医院系统接受LAAO联合左心房CA的患者，并与单纯接受LAAO的对照组进行比较。根据LAAO装置类型（Watchman FLX与Amulet）、CHAD-VASc评分以及高血压、肝肾功能异常、中风、出血史或易感性、国际标准化比值[INR]不稳定、老年、药物/酒精（HAS-BLED）评分进行1:2倾向评分匹配确定对照组，并比较6个月时的安全性、封堵性能和临床结局。
结果
联合治疗组（n = 72）患者比对照组（n = 144）年轻（70.2±7.3岁 vs. 76.7±6.9岁，p < 0.001），但其他方面相当，平均CHAD-VASc评分为4.2±1.1和4.4±1.2（p = 0.26），HAS-BLED评分为2.2±0.8和2.3±0.7（p = 0.34）。LAAO成功植入率相同（95.8% vs. 95.8%，p = 0.99），联合治疗组手术时间更长（156.5±53 vs. 56±26分钟，p < 0.001）。联合治疗组和对照组的主要（1.4% vs. 2.1%，p = 0.72）和次要（27.8% vs. 19.4%，p = 0.17）住院并发症相似。在45天时，经食管超声心动图显示的装置周围渗漏（18.3% vs. 30.4%，p = 0.07）和与装置相关的血栓形成（4.5% vs. 4.5%，p = 0.96）无差异。最后，随访期间的全因死亡率（0% vs. 1.4%，p = 0.99）、血栓栓塞（0% vs. 0%，p = 0.99）和出血（6.1% vs. 4.4%，p = 0.73）事件相当。
结论
这项大型真实世界分析表明，与单纯LAAO相比，LAAO联合CA具有相当的安全性和有效性。
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