两种盘式封堵器预防心房颤动患者血栓栓塞的疗效比较  

Comparison of efficacy of two occluders for thromboembolic prevention in patients with atrial fibrillation

作　　者：丰明俊[1] 储慧民[1] 林华明 何斌[1] 傅国华[1] 王彬浩 杜先锋[1] 郁一波[1] 刘晶[1] Feng Mingjun;Chu Huimin;Lin Huaming;He Bin;Fu Guohua;Wang Binhao;Du Xianfeng;Yu Yibo;Liu Jing(Arrhythmia Center,Ningbo First Hospital,Ningbo 315000,China;Department of Emergency,Quhua Hospital,Quzhou 324000,China)

机构地区：[1]宁波市第一医院心律失常诊疗中心,宁波315000 [2]衢州市衢化医院急诊科,衢州324000

出　　处：《中华心律失常学杂志》2022年第3期293-298,共6页Chinese Journal of Cardiac Arrhythmias

基　　金：浙江省基础公益研究计划项目(LGJ20H20001)。

摘　　要：目的比较两种不同类型的盘式左心耳封堵器预防非瓣膜性心房颤动(房颤)患者血栓栓塞的安全性及有效性。方法入选2016年1月至2020年12月在宁波市第一医院心内科住院行经皮下左心耳封堵术的非瓣膜性房颤患者255例,其中男164例(64.3%,164/255),年龄(70.3±9.0)岁。根据封堵器类型分为LAmbre组132例和ACP组123例,收集两组患者围术期主要并发症,术后封堵器表面血栓(DRT)、血栓栓塞及主要出血事件等发生情况,并比较两组患者主要安全终点和主要疗效终点事件发生率。结果与ACP组相比LAmbre组左心耳口部直径较大[(28.5±5.4)mm对(25.3±4.5)mm,P<0.001],阵发性房颤比例稍低(16.7%对26.8%,P=0.049),其余基线资料差异无统计学意义。LAmbre组和ACP组植入成功率分别为99.2%和100%(P=1.000)。LAmbre组和ACP组术后分别有120例和114例完成影像学随访,发现5例(4.2%,5/120)和6例(5.3%,6/114)DRT,两组比较差异无统计学意义(P=0.692)。LAmbre组和ACP组随访时间分别为(1.6±1.0)年和(3.6±1.2)年,总随访人年数分别为215.8人年和370.5人年。LAmbre组出现主要安全终点事件5例(3.8%,5/132;2.3/百人年),ACP组5例(4.1%,5/123;1.3/百人年),两组比较差异无统计学意义(P=1.000);LAmbre组出现主要疗效终点事件2例(1.5%,2/132;0.9/百人年),ACP组3例(2.4%,3/123;0.8/百人年),两组比较差异无统计学意义(P=0.676)。结论两种不同类型的盘式左心耳封堵器(LAmbre和ACP)预防非瓣膜性房颤患者血栓栓塞的安全性及有效性相当。Objective To compare the safety and efficacy of two different left atrial appendage plug occluders for thromboembolic prevention in patients with nonvalvular atrial fibrillation.Methods A total of 255 patients treated with percutaneous left atrial appendage closure in the Department of Cardiology of Ningbo First Hospital from January 2016 to December 2020 were included in the study.The Patients was divided into two groups according to the type of devices:LAmbre group(n=132)and Amplatzer Cardiac Plug(ACP)group(n=123).Major periprocedural complications were recorded.Left atrial appendage imaging follow-up was performed to detected device-related thrombus(DRT).Thromboembolic and major bleeding events were recorded during follow-up.Finally,the primary safety and efficacy endpoints were compared between groups.Results Left atrial appendage orifice diameter[(28.5±5.4)mm vs.(25.3±4.5)mm,P<0.001]was greater in the LAmbre group.The percentage of paroxysmal atrial fibrillattion(16.7%vs.26.8%,P=0.049)was lower in the LAmbre group.Device implantation success rates in LAmbre group and ACP group were 99.2%and 100%(P=1.000).The incidence of DRT was comparable between groups[4.2%(5/120,LAmbre)vs.5.3%(6/144,ACP),P=0.692].After(1.6±1.0)years and(3.6±1.2)years,clinical safety[3.8%(5/132,LAmbre)vs.4.1%(5/123,ACP),P=1.000]as well as efficacy[1.5%(2/132,LAmbre)vs.2.4%(3/123,ACP),P=0.676]were comparable.Conclusion The LAmbre is efficacy and safety in preventing thromboembolism in patients with nonvalvular atrial fibrillation.

关 键 词：心房颤动 心耳 栓塞保护装置 预防 血栓栓塞 

分 类 号：R541.75[医药卫生—心血管疾病]