Lin Shu-I, Chen Chun-Yen, Chen Wei-Ta, Wang Chi-Hsu, Hua Chu-Po, Lin Po-Lin, Chiou Wei-Ru, Wang Kuangte, Tsai Cheng-Ting, Lee Ying-Hsiang
Cardiovascular Center, MacKay Memorial Hospital, Taipei.
Department of Medicine, MacKay Medical College, New Taipei City.
Acta Cardiol Sin. 2025 Mar;41(2):251-260. doi: 10.6515/ACS.202503_41(2).20241030A.
Stroke remains a concern in patients with atrial fibrillation despite the efficacy of oral anticoagulants. Left atrial appendage closure has emerged as a treatment option for patients with suboptimal pharmacological therapy.
This retrospective multicenter study aimed to evaluate the feasibility, safety, and outcomes of left atrial appendage occlusion procedures for two different indications. Short-term outcomes between two different methods of general anesthesia during the procedures were also compared.
The study included patients who underwent appendage closure between September 2017 and June 2021. Two indications for the procedures, anticoagulant intolerance, and anticoagulant inadequacy were recorded. One-year outcomes were analyzed between groups. Short-term outcomes were compared between the intravenous general anesthesia with high-flow nasal cannula oxygen therapy and intubated general anesthesia groups.
A total of 75 consecutive patients were enrolled: 19 patients in the anticoagulant inadequacy group and 56 in the anticoagulant intolerance group. Appendage occlusion was effective in reducing stroke risk in atrial fibrillation patients with suboptimal pharmacological therapy. There were no significant differences in outcomes between the two indication groups. Appendage closure under high-flow nasal cannula oxygen therapy was found to be feasible and safe, with comparable results to intubated general anesthesia.
Appendage occlusion is effective and safe for Taiwan National Health Insurance-approved indications, with no difference between indication groups during 1-year of follow-up. Appendage occlusion under high-flow nasal cannula oxygen therapy is feasible and comparable to intubated general anesthesia. Larger randomized studies with longer follow-up are needed to confirm these findings.
尽管口服抗凝药有效，但心房颤动患者的中风仍是一个令人担忧的问题。左心耳封堵已成为药物治疗效果欠佳患者的一种治疗选择。
这项回顾性多中心研究旨在评估两种不同适应症的左心耳封堵术的可行性、安全性和结局。同时还比较了手术过程中两种不同全身麻醉方法的短期结局。
该研究纳入了2017年9月至2021年6月期间接受心耳封堵的患者。记录了手术的两种适应症，即抗凝不耐受和抗凝不足。分析了组间的一年结局。比较了高流量鼻导管给氧静脉全身麻醉组和气管插管全身麻醉组的短期结局。
共连续纳入75例患者：抗凝不足组19例，抗凝不耐受组56例。心耳封堵术可有效降低药物治疗欠佳的心房颤动患者的中风风险。两个适应症组的结局无显著差异。发现高流量鼻导管给氧下心耳封堵术可行且安全，结果与气管插管全身麻醉相当。
对于台湾国民健康保险批准的适应症，心耳封堵术有效且安全，随访1年期间各适应症组之间无差异。高流量鼻导管给氧下心耳封堵术可行，且与气管插管全身麻醉相当。需要进行更大规模、随访时间更长的随机研究来证实这些发现。
