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左心耳封堵联合导管消融治疗心房颤动的有效性和安全性

Efficacy and safety in combination of left atrial appendage closure with catheter ablation for the treatment of atrial fibrillation

摘要:

目的 导管消融对于心房颤动(房颤)患者的节律控制疗效确切,但仍不能完全去除脑卒中的风险.而左心耳封堵已在预防房颤脑卒中方面显示出一定的优势.本研究的目的在于明确联合左心耳封堵及导管消融治疗房颤的有效性和安全性.方法 本研究共入选自2014年8月至2016年4月在上海同济大学附属第十人民医院心内科住院的脑卒中风险高危的阵发性房颤患者68例,其中男41例,女27例,平均年龄(75.6±4.3)岁.房颤病史平均(3.1±1.7)年.CHA2 DS2-VASc评分(4.3±1.9)分.所有患者都有脑卒中史,轻者仅表现为一过性脑缺血发作(TIA),重者表现为大面积脑梗死.术前3d内完成经食管超声心动图(TEE)检查,排除左心房内血栓.导管消融的术式是环肺静脉线性消融,终点为完成双侧肺静脉的电隔离;随即于左心耳内植入Lefort封堵器.术后45 d内口服华法林(或新型口服抗凝药)+阿司匹林+氯吡格雷,随后服阿司匹林+氯吡格雷6个月,之后长期维持口服阿司匹林.于第3、6、12、18、24个月时随访心律状态及脑卒中再发的情况.结果 所有患者均成功完成了导管消融+左心耳封堵术.平均随访(13.4±2.8)个月,有58例(85.3%)患者维持窦性心律.无1例患者再发脑卒中.仅1例患者出现轻微的心包渗液,未行特殊处理自行吸收.结论 对于脑卒中风险高危的房颤患者,同时行导管消融及左心耳封堵是可行的,且安全、有效.

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abstracts:

Objective Catheter ablation could not eliminate risks of stroke absolutely in patients with atrial fibrillation (AF).Left atrial appendage closure (LAAC) had showed benefits in prevention of stroke in patients with AF.This study was to evaluate the safety and efficacy in combination of LAAC with catheter ablation for the treatment of AF.Methods Sixty-eight patients (M,41) with paroxysmal AF were enrolled into this study,with a mean age of (75.6±4.3) y.The duration of AF was (3.1±1.7)y,with a CHA2DS2-VASc score of (4.3± 1.9).All the patients had a history of stroke (from transient ischemia attack to hemiplegy).While transesophageal echocardiography (TEE) confirmed that there was no left atrial thrombus in all the patients 72 h before procedure.Circumferential pulmonary vein isolation was performed in all the patients.After that,LAAC was performed with Lefort closer device in the same procedure.Oral warfarin (or new oral anticoagulants)with aspirin and clopidogrel were taken for 45 days after procedure.Then aspirin and clopidogrel were taken till 6 months.After that,oral aspirin was maintained.Heart rhythm status and recurrence of stroke were evaluated at 3,6,12,18 and 24 months after procedure.Results Both catheter ablation and LAAC were performed in all patients.With a mean duration of (13.4±2.8) months of follow-up,58 patients maintained sinus rhythm.No stroke event was observed among these patients.There was no severe procedure related complications in all the patients.Conclusion This study showed the feasibility,safety and efficacy of combination of LAAC with catheter ablation for the treatment of AF in patients with high risks of stroke.

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