同期房颤消融与左心耳封堵的结果：一项回顾性单中心经验
Outcomes of Concomitant Atrial Fibrillation Ablation and Left Atrial Appendage Closure: A Retrospective Single-Center Experience.
作者信息
Alzahrani Ashraf, Wazni Oussama M, Hussein Ayman, Tabaja Chadi, Karmali Rehan, Sajja Himanshu, Klein Benjamin, Alkharabsheh Saqer, Younis Arwa, Sipko Joseph, Al Dalakta Astefanos, Syed Batool Alveena, Donnelan Eoin, Nakhla Shady, Baranowski Bryan, Bhargava Mandeep, Callahan Thomas, Dresing Thomas, Santangeli Pasquale, Martin David, Rickard John, Higuchi Koji, Sroubek Jakub, Jaber Wael A, Kapadia Samir R, Taigen Tyler, Saliba Walid, Kanj Mohamed
机构信息
Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
Section of Clinical Cardiac Electrophysiology, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
出版信息
JACC Adv. 2024 Nov 14;3(12):101377. doi: 10.1016/j.jacadv.2024.101377. eCollection 2024 Dec.
BACKGROUND
Catheter ablation is an effective therapy in the management of atrial fibrillation (AF). Left atrial appendage closure (LAAC) is an alternative to anticoagulation for stroke prevention in patients with bleeding risks.
OBJECTIVES
The purpose of this study was to assess the safety and efficacy of combining AF ablation and LAAC in a single procedure.
METHODS
This retrospective observational study included consecutive patients who underwent concomitant AF ablation and LAAC between June 2015 and August 2021. We assessed the safety and efficacy of the combined procedure with respect to procedural success, periprocedural complications, thromboembolism, bleeding, and arrhythmia recurrence.
RESULTS
A total of 178 patients (mean age 72.1 ± 8.7 years, 60.7% male) were identified. The mean CHADSVASc and HAS-BLED scores were 4.0 ± 1.4 and 2.8 ± 1.1, respectively. Pulmonary vein isolation was achieved in all patients. LAAC was aborted in 15 cases (success rate of 91.6%). The periprocedural complications rate was 6.2%. The median follow-up duration was 412 days IQR: 213 to 781 days. There were 2 strokes and 3 transient ischemic attacks, equating to an annual risk of 1.7% at 1 year and 4.6% at 2 years. Complete seal was achieved in 97.5% intraprocedurally and in 73.7% on initial follow-up, with no major leaks identified. There were 2 cases (1.3%) of device-related thrombus that resolved with anticoagulation. Thirty-four bleeding events occurred in 28 patients (17.4%). Anticoagulation was discontinued in 93.8% of patients.
CONCLUSIONS
Concomitant AF ablation and LAAC could be considered in appropriate patients in centers of clinical expertise.
背景
导管消融是治疗心房颤动（AF）的有效方法。左心耳封堵术（LAAC）是有出血风险患者预防卒中的抗凝替代方案。
目的
本研究旨在评估在同一手术中联合进行房颤消融和左心耳封堵术的安全性和有效性。
方法
这项回顾性观察性研究纳入了2015年6月至2021年8月期间连续接受房颤消融和左心耳封堵术的患者。我们从手术成功率、围手术期并发症、血栓栓塞、出血和心律失常复发方面评估了联合手术的安全性和有效性。
结果
共纳入178例患者（平均年龄72.1±8.7岁，男性占60.7%）。CHADSVASc和HAS - BLED评分的平均值分别为4.0±1.4和2.8±1.1。所有患者均实现肺静脉隔离。15例左心耳封堵术中止（成功率为91.6%）。围手术期并发症发生率为6.2%。中位随访时间为412天（四分位间距：213至781天）。发生2例卒中、3例短暂性脑缺血发作，1年时年风险为1.7%，2年时为4.6%。术中97.5%实现完全封堵，初次随访时为73.7%，未发现大的渗漏。有2例（1.3%）与器械相关的血栓，经抗凝治疗后消失。28例患者（17.4%）发生34次出血事件。93.8%的患者停用了抗凝药物。
结论
在具备临床专业知识的中心，符合条件的患者可考虑同时进行房颤消融和左心耳封堵术。
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