左心耳封堵预防心房颤动患者卒中的研究进展

Progress in Prevention of Stroke in Patients with Atrial Fibrillation by Left Atrial Appendage Occlusion

预防心房颤动患者发生卒中的常用方法包括抗凝药物(华法林、新型口服抗凝药物等)及左心耳封堵(left atrial appendage occlusion,LAAO)治疗。近年来,一些研究表明LAAO在预防心房颤动患者卒中方面,不劣于华法林治疗,甚至在某些研究中优于华法林治疗,而关于LAAO与新型口服抗凝药对比的随机研究尚不充分。目前更新的文献提示,LAAO造成长期心房颤动患者相关门诊率和住院率升高,且可能对心房颤动的发生及发展产生一定影响,引起一些争议。这提示在临床实践中,重要的是严格把握手术适应证,综合长期获益与风险评估,准确判断适合进行LAAO的患者人群。

Common methods for preventing stroke in patients with atrial fibrillation (AF) includes anticoagulant drugs, such as warfarin and new oral anticoagulants (NOAC), and left atrial appendage occlusion (LAAO). In recent years, some studies have shown that LAAO was not inferior to warfarin in the prevention of stroke in AF patients, and even better than warfarin, while randomized comparative studies of LAAO and NOAC are very few. However, the recent study suggested that LAAO increased the long-term AF-related outpatient care visit rate and hospitalization rate in AF patients, and might have an impact on the occurrence and development of AF, which brought some controversy. This suggested us that it is important to identify the indications of LAAO in clinical practice, and the patients suitable for LAAO should be strictly selected according to the comprehensive assessment of long-term benefit and risk.