心房颤动导管消融联合左心耳封堵一站式手术的可行性和围术期安全性分析

Feasibility and perioperative safety of the combined procedure of catheter ablation and watchman left atrial appendage closure

目的:探讨在单次手术中进行导管消融和左心耳封堵术的心房颤动(房颤)一站式治疗的可行性和围术期安全性。方法:该研究为观察性研究。连续入选2017年3月至2019年5月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消融和Watchman左心耳封堵术的一站式治疗。评估患者的基线特征、手术成功率和围术期严重不良事件。结果:共纳入358例房颤患者,男性189例(52.8%),年龄(69.0±8.0)岁,其中阵发性房颤162例(45.3%),持续或长程持续性房颤196例(54.7%),CHA 2DS 2-VASc评分(3.2±1.5)分,HAS-BLED评分(2.4±1.1)分。其中350例(97.8%)为先消融后封堵,8例(2.2%)为先封堵后消融;射频消融353例(98.6%),冷冻消融5例(1.4%)。所有患者成功完成肺静脉隔离,其中180例(50.3%)患者附加线性消融和/或基质改良。Watchman左心耳封堵器置入成功率为100%(358/358)。围术期严重不良事件共14例(3.9%)。其中操作相关的严重不良事件12例(3.4%),包括6例(1.7%)心包积液、1例(0.3%)卒中和5例(1.4%)血管穿刺并发症;2例(0.6%)患者发生急性左心衰竭;无大出血和死亡事件发生。结论:对症状性、非瓣膜性房颤患者,导管消融联合左心耳封堵的一站式治疗具有良好的可行性和围术期安全性。

Objective We aimed to explore the feasibility and perioperative safety of performing catheter ablation and left atrial appendage closure(LAAC)in a single(one-stop)session in patients with atrial fibrillation(AF).Methods This study is an observational study.Consecutive AF patients who underwent the combined procedure of catheter ablation and LAAC with Watchman device of Xinhua Hospital in Shanghai between March 2017 and May 2019 were prospectively enrolled.Baseline,intra-and peri-procedural parameters were evaluated.Results A total of 358 AF patients(189 males,(69.0±8.0)years)underwent the one-stop procedure.The CHA2DS2-VASc score was 3.2±1.5 and HAS-BLED score was 2.4±1.1,respectively in this patient cohort.Pulmonary vein isolation was achieved in all patients,while additional linear ablation was applied in 180(50.3%)patients,yielding immediate success rate of 99.7%.Successful Watchman implantation was achieved in all patients.The perioperative serious adverse event occurred in 14 cases(3.9%).including 6 pericardial effusions(1.7%),1 stroke(0.3%)and 5 vascular complications(1.4%),yielding procedure-related complication rate of 3.4%.In addition,2(0.6%)new-onset heart failures occurred postoperatively.There was no major bleeding or death during the perioperative period.Conclusions Combined catheter ablation and LAAC can be successfully and safely performed in AF patients with high stroke risk.Follow-up data are needed to evaluate the outcome of this one-stop procedure.