左心耳封堵术对非瓣膜性心房颤动合并冠状动脉性心脏病的价值

Value of Left Atrial Appendage Closure on Non-Valvular Atrial Fibrillation with Coronary Heart Disease

非瓣膜性心房颤动合并冠状动脉性心脏病患者的抗栓策略目前尚存争议,部分患者面临高缺血和/或高出血风险。现有指南大多推荐心房颤动合并急性冠脉综合征和/或经皮冠状动脉介入治疗患者应于早期接受三联抗栓治疗,推荐心房颤动合并慢性冠脉综合征患者接受单联口服抗凝药物预防缺血性心脑血管事件,但缺血与出血事件的有效平衡仍是临床中的棘手问题。左心耳封堵术作为心房颤动患者的抗凝替代治疗可同时减少缺血和出血事件,或可改变心房颤动合并冠状动脉性心脏病患者的治疗格局,现就这一领域的相关进展做一综述。

The anti-thrombotic strategies in patients of non-valvular atrial fibrillation with coronary heart disease are currently controversial,and some patients are facing with high ischemic and/or high hemorrhagic risk.Most of the guidelines recommend that the atrial fibrillation with acute coronary syndrome and/or percutaneous coronary intervention patients should receive triple anti-thrombotic therapy in the early stage,and atrial fibrillation with chronic coronary syndrome patients should accept single anticoagulant therapy to prevent ischemic cardiovascular and cerebrovascular incidents.But the effective balance of ischemic and hemorrhagic events are still a difficult problem in clinical practice.Left atrial appendage closure,as anti-coagulation replacement therapy in patients with atrial fibrillation,can simultaneously reduce ischemic and hemorrhagic incidents,which can change the treatment pattern of patients with atrial fibrillation with coronary heart disease.This article will review related progress in this field.