左心耳封堵在非瓣膜性心房颤动卒中的预防作用

Role of percutaneous left atrial appendage occlusion in stroke prevention for nonvalvular atrial fibrillation

血栓栓塞事件是心房颤动(房颤)最严重的并发症,及早识别并预防其栓塞风险至关重要。传统的抗凝治疗在预防非瓣膜性房颤患者的血栓栓塞事件方面存在一定局限性。左心耳部被证实为房颤患者血栓形成的主要部位,这一发现促使了经皮左心耳封堵技术的迅速发展。与抗凝药物相比,经皮左心耳封堵术可有效降低房颤患者血栓栓塞事件的发生率,且适用于抗凝禁忌的房颤患者。目前,WATCHMAN与ACP封堵装置已被授权进入欧盟市场,LARIAT左心耳结扎装置也因其有效性及安全性被美国FDA批准应用。经皮左心耳封堵及结扎术的适应证广,安全性高,有望成为多数房颤患者预防血栓栓塞事件的选择。

Thromboembolism is the most serious complication in patients with atrial fibrillation（AF）.It is crucial to predict and reduce the thromboembolic risk as soon as possible.Chronic anticoagulaion therapy has certain limitations in the prevention of thromboembolic events.Left atrial appendage（LAA）was confirmed as the main part of thrombus formation in patients with nonvalvular AF.As a result,percutaneous LAA occlusion has been advocated as a strategy for the prevention of thromboembolic event.LAA occlusion can effectively reduce the incidence of thromboembolic events in patients with nonvalvular AF and was also considered for patients with contraindications to oral anticoagulation.The WATCHMAN and ACP device have been authorized to enter the European Union market.LARIAT ligation device was also approved by US Food and Drug Administration because of its efficacy and safety.Due to its wide indications and high safety,percutaneous LAA occlusion or suture ligation is expected to become a reasonable alternative to prevent thromboembolic events for most patients with AF.