左心房阑尾关闭术后心房颤动消融的安全性和可行性：左心房阑尾封闭第一策略的单中心经验

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia Pub Date : 2024-05-23 DOI:10.1002/joa3.13073

Ryuki Chatani MD, Shunsuke Kubo MD, Hiroshi Tasaka MD, Atsushi Sakata MD, Mitsuru Yoshino MD, Takeshi Maruo MD, Kazushige Kadota MD, PhD

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引用次数: 0

摘要

不适合接受长期抗凝治疗的心房颤动（房颤）患者会接受经皮左心房阑尾关闭术（LAAC）。LAAC 后进行左心房导管消融术（CA）的安全性和可行性仍不清楚。这项研究旨在明确 LAAC 后 CA 的可行性和安全性，包括在 180 天内的早期阶段。研究人员比较了 46 名在 2 年内同时接受 CA 和 LAAC 的房颤患者（平均年龄 72 岁，29 名男性）的特征和临床结果，先接受 CA 的患者（31 名）和先接受 LAAC 的患者（15 名）的特征和临床结果。LAAC-first策略通常用于既往有大出血和LAA血栓或淤血的患者。在LAAC-first组中，两次手术之间的平均间隔时间为212天，所有LAAC-first患者，包括早期阶段的7名患者，均可接受CA，且未出现LAAC装置相关并发症；此外，两次手术后均未报告心血管不良事件（平均间隔时间：420天）。在LAAC术后进行CA后，未观察到与器械相关的不良事件（与器械相关的血栓形成、新的器械周围渗漏出现、器械周围渗漏增加或器械脱落），而在LAAC术后进行CA后，观察到3例新的器械周围渗漏出现事件和1例器械周围渗漏增加事件，尤其是在LAAC术后早期阶段接受LAAC的患者。

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Safety and feasibility of atrial fibrillation ablation after left atrial appendage closure: A single-center experience of the left atrial appendage closure first strategy

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Safety and feasibility of atrial fibrillation ablation after left atrial appendage closure: A single-center experience of the left atrial appendage closure first strategy

Background

Patients with atrial fibrillation (AF) who are not suitable for long-term anticoagulant therapy undergo percutaneous left atrial appendage closure (LAAC). The safety and feasibility of left atrial catheter ablation (CA) procedures after LAAC remain unclear. This study aimed to clarify the feasibility and safety of CA after LAAC, including in the early phase within 180 days.

Methods

Characteristics and clinical outcomes of 46 patients with AF who had undergone both CA and LAAC within 2 years (mean age, 72 years; 29 men) were compared between those who had undergone CA-first (31 patients) and LAAC-first (15 patients).

Results

The mean CHA₂DS₂-VASc and HAS-BLED scores were 4.8 and 3.3 points, respectively. The LAAC-first strategy was often used in patients with prior major bleeding and LAA thrombosis or sludge. In the LAAC-first group, the mean duration between both procedures was 212 days, and all LAAC-first patients, including seven patients in the early phase, could undergo CA without LAAC device-related complications; moreover, no cardiovascular adverse events were reported after both procedures (mean periods: 420 days). After CA post-LAAC, no device-related adverse events (device-related thrombosis, new peri-device leak appearance, peri-device leak increase, or device dislodgement) were observed, whereas, after LAAC post-CA, 3 new peri-device leak appearance events and 1 peri-device leak increase event were observed, especially patients who underwent LAAC in the early phase post-CA.