导管消融联合左心耳封堵一站式治疗心房颤动的临床应用  

Clinical application of combined procedure of catheter ablation combined with left atrial appendage closure in patients with atrial fibrillation

作　　者：王群山[1] 莫斌峰[1] 孙健[1] 张澎湃[1] 李威[1] 张睿[1] 陈牧[1] 郁怡[1] 李毅刚[1] Wang Qunshan;Mo Binfeng;Sun Jian;Zhang Pengpai;Li Wei;Zhang Rui;Chen Mu;Yu Yi;Li Yigang(Department of Cardiology,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院心血管内科,200092

出　　处：《中华心律失常学杂志》2021年第6期498-503,共6页Chinese Journal of Cardiac Arrhythmias

基　　金：国家自然科学基金重大研究计划培育项目(91949128);国家自然科学基金(81873485);广东省钟南山医学基金会(ZNSA-2020017-8)。

摘　　要：目的本研究通过单中心较大样本数据进一步评估房颤一站式手术的可行性、安全性和有效性。方法本研究为单中心回顾性研究,连续入选2017年3月至2020年6月在上海交通大学医学院附属新华医院收治的症状性、非瓣膜性房颤患者,在单次手术中进行房颤导管消融和左心耳封堵一站式手术治疗,评估患者的基线特征、术中数据、围术期不良事件和随访结局。结果共纳入723例房颤患者,年龄(69.2±7.7)岁,年龄范围18~90岁,男391例(54.1%,391/723),CHA2DS2-VASc评分为(3.4±1.6)分,HAS-BLED评分为(2.4±1.1)分。成功行左心耳封堵713例(98.6%,713/723),其中670例(94.0%,670/723)完全封堵,43例(6.0%,43/723)存在≤5 mm的残余分流。围术期操作相关的严重不良事件包括8例(1.1%,8/723)需要穿刺抽液的心脏压塞、3例(0.4%,3/723)脑卒中和2例(0.3%,2/723)冠状动脉空气压塞,无栓塞和病死发生。随访(22.5±7.6)个月,房颤复发率为31.1%(222/713)。末次随访时,97.1%(692/713)的患者已停用口服抗凝药物,观察到的实际缺血性脑卒中发生率为0.7/100患者年,与基于CHA2DS2-VASc评分预测的脑卒中事件发生率相比,减少85%的风险。观察到的实际出血事件发生率1.1/100患者年,与基于HAS-BLED评分预测的出血事件发生率相比,减少74%的风险。结论单中心大样本的723例经验总结进一步支持导管消融联合左心耳封堵治疗房颤的可行性、安全性和有效性。Objective This study further evaluated the feasibility,safety and effectiveness of the combined procedure based on a large sample data from a single center.Methods This was a single-center retrospective study.Patients with nonvalvular AF who underwent combined catheter ablation and LAAC in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine between March 2017 and June 2020 were consecutively enrolled.The procedure successful rate,complications and outcomes were evaluated.Results A total of 723 patients(male 391,18-90 years old)were included.The average CHA2DS2-VASc and HAS-BLED scores were 3.4±1.6 and 2.4±1.1,respectively.Successful LAAC was achieved in 98.6%(713/723)of all the patients,with a 94.0%(670/723)complete left atrial appendage occluded rate and a 6.0%(43/723)minimal residual flow(≤5 mm)rate.Procedure-related complications included 8(8/723)1.1% pericardial effusion requiring percutaneous drainage,3(0.4%,3/723,)strokes and 2(0.3%,2/723)coronary air embolisms.There was no device embolism and death during the perioperative period.During follow-up of(22.5±7.6)months,AF recurred in 31.1%(222/723)of the patients.At the end of follow-up,97.1%(692/713)patients discontinued oral anticoagulants.An annualized ischemic stroke and bleeding rate were 0.7 per 100 patient-years(100-PY);and 1.1 per 100-PY,respectively.The risk was reduced by 85%compared with the predicted rate based on CHA2DS2-VASc score and 74%risk reduction of bleeding compared with the predicted rate based on HAS-BLED score.Conclusion The single-center experiences of 723 cases further supports the feasibility,safety and effectiveness of the combined procedure in treating AF.

关 键 词：心房颤动 脑卒中 导管消融 左心耳封堵 一站式 

分 类 号：R654.2[医药卫生—外科学]