{"title":"心内超声引导联合导管消融和左房阑尾封堵术的临床效果和安全性","authors":"Qian Liu, Ling You, Jing Yang, Yan Zhang, Jinglan Wu, Hongning Yin, Yanan Zhang, Ruiqin Xie","doi":"10.31083/j.rcm2506192","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The goal of this study was to compare the procedural safety and long-term outcome associated with a combined catheter ablation and left atrial appendage occlusion (LAAO) procedure utilizing intracardiac echocardiography (ICE) guidance versus transesophageal echocardiography (TEE) guidance. The study focuses on implementing LAmbre and Watchman devices in patients diagnosed with nonvalvular atrial fibrillation (AF).</p><p><strong>Methods: </strong>A total of 363 patients diagnosed with nonvalvular AF and who underwent a combined procedure were prospectively enrolled between November 2017 and May 2022. Following 1:1 propensity score matching, the TEE group (n = 132) and ICE group (n = 132) were systematically compared in terms of the combined procedure, imaging parameters, events related to the procedure, and subsequent outcomes during follow-up, including mortality, stroke, bleeding, device-related thrombus (DRT), and peri-device leaks (PDLs).</p><p><strong>Results: </strong>The ICE group exhibited a significant reduction in total procedural duration (153.71 <math><mo>±</mo></math> 31.71 vs. 174.74 <math><mo>±</mo></math> 18.79 min), fluoroscopy radiation dosage (207.24 <math><mo>±</mo></math> 108.39 vs. 268.61 <math><mo>±</mo></math> 122.88 mGy), left atrial appendage occlusion procedure time (34.69 <math><mo>±</mo></math> 10.91 vs. 51.46 <math><mo>±</mo></math> 15.84 min), and contrast agent exposure (108.71 <math><mo>±</mo></math> 37.59 vs. 158.41 <math><mo>±</mo></math> 45.00 mL) compared to the TEE group. Angiography and ICE demonstrated a substantial correlation between the left atrial appendage (LAA) orifice and landing zone/LAA ostium (Pearson's correlation coefficient r = 0.808 and 0.536/0.697, two-tailed <i>p</i> <math><mo><</mo></math> 0.001). No occurrences of device-related embolism, thromboembolism, significant bleeding, or unexpected fatalities were observed in either group. Comparable rates of all-cause death (0.76% vs. 0.76%), stroke or transient ischemic attack (2.27% vs. 1.52%), severe bleeding (1.52% vs. 0.76%), PDL (23.81% vs. 24.62%), and DRT (1.52% vs. 1.52%) were noted after an average follow-up of 18.46 <math><mo>±</mo></math> 7.70 months in both groups, with no discernible differences. Multivariate logistic regression analysis identified a correlation between LAA velocity and the risk of PDL.</p><p><strong>Conclusions: </strong>The effectiveness and safety of ICE-guided combined treatment were demonstrated to be comparable to TEE guidance, accompanied by the additional advantages of decreased procedure time and fluoroscopy radiation exposure.</p><p><strong>Clinical trial registration: </strong>NCT04391504, https://register.clinicaltrials.gov.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":null,"pages":null},"PeriodicalIF":1.9000,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11270113/pdf/","citationCount":"0","resultStr":"{\"title\":\"Clinical Results and Safety of Intracardiac Echocardiography Guidance for Combined Catheter Ablation and Left Atrial Appendage Occlusion.\",\"authors\":\"Qian Liu, Ling You, Jing Yang, Yan Zhang, Jinglan Wu, Hongning Yin, Yanan Zhang, Ruiqin Xie\",\"doi\":\"10.31083/j.rcm2506192\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The goal of this study was to compare the procedural safety and long-term outcome associated with a combined catheter ablation and left atrial appendage occlusion (LAAO) procedure utilizing intracardiac echocardiography (ICE) guidance versus transesophageal echocardiography (TEE) guidance. The study focuses on implementing LAmbre and Watchman devices in patients diagnosed with nonvalvular atrial fibrillation (AF).</p><p><strong>Methods: </strong>A total of 363 patients diagnosed with nonvalvular AF and who underwent a combined procedure were prospectively enrolled between November 2017 and May 2022. Following 1:1 propensity score matching, the TEE group (n = 132) and ICE group (n = 132) were systematically compared in terms of the combined procedure, imaging parameters, events related to the procedure, and subsequent outcomes during follow-up, including mortality, stroke, bleeding, device-related thrombus (DRT), and peri-device leaks (PDLs).</p><p><strong>Results: </strong>The ICE group exhibited a significant reduction in total procedural duration (153.71 <math><mo>±</mo></math> 31.71 vs. 174.74 <math><mo>±</mo></math> 18.79 min), fluoroscopy radiation dosage (207.24 <math><mo>±</mo></math> 108.39 vs. 268.61 <math><mo>±</mo></math> 122.88 mGy), left atrial appendage occlusion procedure time (34.69 <math><mo>±</mo></math> 10.91 vs. 51.46 <math><mo>±</mo></math> 15.84 min), and contrast agent exposure (108.71 <math><mo>±</mo></math> 37.59 vs. 158.41 <math><mo>±</mo></math> 45.00 mL) compared to the TEE group. Angiography and ICE demonstrated a substantial correlation between the left atrial appendage (LAA) orifice and landing zone/LAA ostium (Pearson's correlation coefficient r = 0.808 and 0.536/0.697, two-tailed <i>p</i> <math><mo><</mo></math> 0.001). No occurrences of device-related embolism, thromboembolism, significant bleeding, or unexpected fatalities were observed in either group. Comparable rates of all-cause death (0.76% vs. 0.76%), stroke or transient ischemic attack (2.27% vs. 1.52%), severe bleeding (1.52% vs. 0.76%), PDL (23.81% vs. 24.62%), and DRT (1.52% vs. 1.52%) were noted after an average follow-up of 18.46 <math><mo>±</mo></math> 7.70 months in both groups, with no discernible differences. Multivariate logistic regression analysis identified a correlation between LAA velocity and the risk of PDL.</p><p><strong>Conclusions: </strong>The effectiveness and safety of ICE-guided combined treatment were demonstrated to be comparable to TEE guidance, accompanied by the additional advantages of decreased procedure time and fluoroscopy radiation exposure.</p><p><strong>Clinical trial registration: </strong>NCT04391504, https://register.clinicaltrials.gov.</p>\",\"PeriodicalId\":20989,\"journal\":{\"name\":\"Reviews in cardiovascular medicine\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2024-05-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11270113/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Reviews in cardiovascular medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.31083/j.rcm2506192\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/6/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Reviews in cardiovascular medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.31083/j.rcm2506192","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/6/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
研究背景本研究的目的是比较使用心内超声心动图（ICE）引导的导管消融和左心房阑尾封堵术（LAAO）联合手术与经食道超声心动图（TEE）引导的导管消融和左心房阑尾封堵术（LAAO）联合手术的安全性和长期疗效。研究重点是在诊断为非瓣膜性心房颤动（房颤）的患者中使用 LAmbre 和 Watchman 装置：2017年11月至2022年5月期间，共有363名确诊为非瓣膜性房颤并接受了联合手术的患者接受了前瞻性研究。经过1:1倾向得分匹配，系统比较了TEE组（n = 132）和ICE组（n = 132）的联合手术、成像参数、手术相关事件以及随访期间的后续结果，包括死亡率、卒中、出血、器械相关血栓（DRT）和器械周围渗漏（PDLs）：结果：与 TEE 组相比，ICE 组的总手术时间（153.71 ± 31.71 vs. 174.74 ± 18.79 分钟）、透视辐射剂量（207.24 ± 108.39 vs. 268.61 ± 122.88 mGy）、左心房阑尾闭塞手术时间（34.69 ± 10.91 vs. 51.46 ± 15.84 分钟）和造影剂暴露量（108.71 ± 37.59 vs. 158.41 ± 45.00 mL）均显著减少。血管造影和 ICE 显示左心房阑尾 (LAA) 孔口和着床区/LAA 孔口之间有很大的相关性（皮尔逊相关系数 r = 0.808 和 0.536/0.697，双尾 p 0.001）。两组均未观察到与装置相关的栓塞、血栓栓塞、大出血或意外死亡。两组平均随访 18.46 ± 7.70 个月后，全因死亡（0.76% vs. 0.76%）、中风或短暂性脑缺血发作（2.27% vs. 1.52%）、严重出血（1.52% vs. 0.76%）、PDL（23.81% vs. 24.62%）和 DRT（1.52% vs. 1.52%）的发生率相当，无明显差异。多变量逻辑回归分析确定了LAA速度与PDL风险之间的相关性：ICE引导下的联合治疗的有效性和安全性与TEE引导下的治疗效果相当，同时还具有减少手术时间和透视辐射暴露的额外优势：临床试验注册：NCT04391504，https://register.clinicaltrials.gov。
Clinical Results and Safety of Intracardiac Echocardiography Guidance for Combined Catheter Ablation and Left Atrial Appendage Occlusion.
Background: The goal of this study was to compare the procedural safety and long-term outcome associated with a combined catheter ablation and left atrial appendage occlusion (LAAO) procedure utilizing intracardiac echocardiography (ICE) guidance versus transesophageal echocardiography (TEE) guidance. The study focuses on implementing LAmbre and Watchman devices in patients diagnosed with nonvalvular atrial fibrillation (AF).
Methods: A total of 363 patients diagnosed with nonvalvular AF and who underwent a combined procedure were prospectively enrolled between November 2017 and May 2022. Following 1:1 propensity score matching, the TEE group (n = 132) and ICE group (n = 132) were systematically compared in terms of the combined procedure, imaging parameters, events related to the procedure, and subsequent outcomes during follow-up, including mortality, stroke, bleeding, device-related thrombus (DRT), and peri-device leaks (PDLs).
Results: The ICE group exhibited a significant reduction in total procedural duration (153.71 31.71 vs. 174.74 18.79 min), fluoroscopy radiation dosage (207.24 108.39 vs. 268.61 122.88 mGy), left atrial appendage occlusion procedure time (34.69 10.91 vs. 51.46 15.84 min), and contrast agent exposure (108.71 37.59 vs. 158.41 45.00 mL) compared to the TEE group. Angiography and ICE demonstrated a substantial correlation between the left atrial appendage (LAA) orifice and landing zone/LAA ostium (Pearson's correlation coefficient r = 0.808 and 0.536/0.697, two-tailed p 0.001). No occurrences of device-related embolism, thromboembolism, significant bleeding, or unexpected fatalities were observed in either group. Comparable rates of all-cause death (0.76% vs. 0.76%), stroke or transient ischemic attack (2.27% vs. 1.52%), severe bleeding (1.52% vs. 0.76%), PDL (23.81% vs. 24.62%), and DRT (1.52% vs. 1.52%) were noted after an average follow-up of 18.46 7.70 months in both groups, with no discernible differences. Multivariate logistic regression analysis identified a correlation between LAA velocity and the risk of PDL.
Conclusions: The effectiveness and safety of ICE-guided combined treatment were demonstrated to be comparable to TEE guidance, accompanied by the additional advantages of decreased procedure time and fluoroscopy radiation exposure.
期刊介绍：
RCM is an international, peer-reviewed, open access journal. RCM publishes research articles, review papers and short communications on cardiovascular medicine as well as research on cardiovascular disease. We aim to provide a forum for publishing papers which explore the pathogenesis and promote the progression of cardiac and vascular diseases. We also seek to establish an interdisciplinary platform, focusing on translational issues, to facilitate the advancement of research, clinical treatment and diagnostic procedures. Heart surgery, cardiovascular imaging, risk factors and various clinical cardiac & vascular research will be considered.
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