心房颤动合并左心耳血栓前期患者行导管消融术的安全性与可行性探讨

Safety and feasibility of catheter ablation in patients with atrial fibrillation and left atrial appendage sludge

目的初步探讨心房颤动(房颤)合并左心耳血栓前期患者行导管消融术的安全性与可行性。方法前瞻性连续入选2020年1月1日至2021年12月1日,在北京安贞医院房颤中心接受导管消融术的房颤合并左心耳血栓前期的患者。收集患者的一般临床资料、超声心动图、实验室检查结果、药物治疗、房颤导管消融术及左心耳封堵术(LAAO)数据。于术后第3、6和12个月进行电话或门诊随访。记录患者在院期间及出院后手术相关并发症发生情况,包括死亡、血栓栓塞、血管穿刺并发症等。结果共纳入9例患者,年龄(68.8±10.2)岁,其中男8例。9例均为持续性房颤,房颤持续时间3(1,5)年。9例患者房颤导管消融术后均达到双侧肺静脉电隔离,且消融径线达到完全阻滞。其中5例患者同期行LAAO,术中检查未见残余分流及器械移位。中位随访时间6个月,9例患者围术期均未发生手术相关死亡、血栓栓塞事件、血管穿刺并发症、心脏压塞、心房食管瘘。1例患者出现心包积液,后自行吸收。结论房颤合并左心耳血栓前期的患者行导管消融术同期行或不行LAAO可能是安全、可行的。研究结论仍需扩大样本量进一步研究证实。

Objective To evaluate the safety and feasibility of catheter ablation in patients with atrial fibrillation(AF)and left atrial appendage(LAA)sludge.Methods Patients with AF and LAA sludge who underwent catheter ablation were enrolled consecutively from 1st January,2020 to 1st December,2021 in Center of Atrial Fibrillation,Beijing Anzhen Hospital.The general clinical data,echocardiographic results,laboratory test results,drug therapy,catheter ablation and left atrial appendage occlusion(LAAO)were collected.Patients were followed up at 3,6 and 12 months after the procedure by telephone or via outpatient service.We recorded the procedure-related complications both in-hospital and post-discharge,including death,thromboembolism,vascular access complications and so on.Results Nine patients were included in the study,the average age was(68.8±10.2)years old,and eight were male.Nine patients were all diagnosed with persistent AF.The median duration of AF was 3(1,5)years.The nine patients all achieved bilateral pulmonary veins electrical isolation and complete block of ablation lines.Among them,five patients underwent synchronous LAAO,there were no residual shunt and device translocations during operation.After a median follow-up of six months,there were no perioperative death,thromboembolism,vascular access complications,cardiac tamponade,atrial-esophageal fistula.Only one patient developed pericardial effusion,which was absorbed spontaneously.Conclusion It may be safe and feasible for patients with AF and LAA sludge to undergo catheter ablation with/without synchronous LAAO.Further studies with larger patient cohort are warranted to confirm this conclusion.