Khalid Sawalha, Mohammad Alakchar, Mamas A Mamas, Dana Johnson, Adarsh Bhan, Andrew M Goldsweig
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Studies comparing outcomes of patients undergoing DCCV after LAAO, with versus without subsequent anticoagulation, were included. Primary outcomes were thromboembolic events and clinically significant bleeding. Odds ratios (ORs) were calculated using random-effects modeling, with heterogeneity assessed via I<sup>2</sup> statistic.</p><p><strong>Results: </strong>Five observational studies (1697 DCCV procedures; 965 patients receiving post-DCCV anticoagulation) met inclusion criteria. Thromboembolic events occurred in 3.8 % of patients without OAC versus 1.6 % with OAC, with no statistically significant difference (OR 0.48; 95 % CI 0.16-1.43; p = 0.19; I<sup>2</sup> = 17 %). Clinically significant bleeding occurred in 4.1 % without OAC and 4.0 % with OAC, also without significant difference (OR 1.22; 95 % CI 0.75-2.00; p = 0.42; I<sup>2</sup> = 0 %). Pre-DCCV imaging protocols varied widely among studies.</p><p><strong>Conclusions: </strong>In selected patients post-LAAO with no device-related thrombus or significant peri-device leak, DCCV without subsequent anticoagulation demonstrated low thromboembolic and bleeding risks. 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引用次数: 0
摘要
背景：直流电复律（DCCV）常用于房颤（AF）的心律控制。左心耳闭塞术（LAAO）可预防口服抗凝（OAC）禁忌症患者的脑卒中，但在该组患者中，不进行围手术期抗凝的DCCV的安全性仍不确定。目的：评价既往LAAO患者在不进行全身抗凝的情况下行DCCV的安全性。方法：我们按照PRISMA指南进行了系统回顾和荟萃分析。检索PubMed、ScienceDirect和Cochrane图书馆（2010年1月- 2025年4月）。研究比较了LAAO后DCCV患者的结果，有和没有后续抗凝治疗。主要结局是血栓栓塞事件和临床显著出血。使用随机效应模型计算优势比（ORs），通过I2统计量评估异质性。结果：5项观察性研究（1697例DCCV手术，965例接受DCCV后抗凝治疗的患者）符合纳入标准。无OAC患者发生血栓栓塞事件的比例为3.8%，有OAC患者为1.6%，差异无统计学意义（OR 0.48; 95% CI 0.16-1.43; p = 0.19; I2 = 17%）。无OAC和OAC的临床显著出血发生率分别为4.1%和4.0%，差异无统计学意义（OR 1.22; 95% CI 0.75-2.00; p = 0.42; I2 = 0%）。dccv前成像方案在不同的研究中差异很大。结论：在laao后没有器械相关血栓或明显器械周围泄漏的患者中，不进行抗凝治疗的DCCV显示出较低的血栓栓塞和出血风险。这些发现来自有限的观察数据，需要通过随机对照试验来证实。
Safety of cardioversion without anticoagulation in patients' status post left atrial appendage occlusion: A systematic review and meta-analysis.
Background: Direct current cardioversion (DCCV) is commonly used for rhythm control in atrial fibrillation (AF). Left atrial appendage occlusion (LAAO) provides stroke prevention in patients with contraindications to oral anticoagulation (OAC), but the safety of DCCV without periprocedural anticoagulation in this group remains uncertain.
Objective: To evaluate the safety of performing DCCV without systemic anticoagulation in patients with prior LAAO.
Methods: We conducted a systematic review and meta-analysis following PRISMA guidelines. PubMed, ScienceDirect, and the Cochrane Library were searched (January 2010-April 2025). Studies comparing outcomes of patients undergoing DCCV after LAAO, with versus without subsequent anticoagulation, were included. Primary outcomes were thromboembolic events and clinically significant bleeding. Odds ratios (ORs) were calculated using random-effects modeling, with heterogeneity assessed via I2 statistic.
Results: Five observational studies (1697 DCCV procedures; 965 patients receiving post-DCCV anticoagulation) met inclusion criteria. Thromboembolic events occurred in 3.8 % of patients without OAC versus 1.6 % with OAC, with no statistically significant difference (OR 0.48; 95 % CI 0.16-1.43; p = 0.19; I2 = 17 %). Clinically significant bleeding occurred in 4.1 % without OAC and 4.0 % with OAC, also without significant difference (OR 1.22; 95 % CI 0.75-2.00; p = 0.42; I2 = 0 %). Pre-DCCV imaging protocols varied widely among studies.
Conclusions: In selected patients post-LAAO with no device-related thrombus or significant peri-device leak, DCCV without subsequent anticoagulation demonstrated low thromboembolic and bleeding risks. These findings, derived from limited observational data, require confirmation by randomized controlled trials.
期刊介绍：
Cardiovascular Revascularization Medicine (CRM) is an international and multidisciplinary journal that publishes original laboratory and clinical investigations related to revascularization therapies in cardiovascular medicine. Cardiovascular Revascularization Medicine publishes articles related to preclinical work and molecular interventions, including angiogenesis, cell therapy, pharmacological interventions, restenosis management, and prevention, including experiments conducted in human subjects, in laboratory animals, and in vitro. Specific areas of interest include percutaneous angioplasty in coronary and peripheral arteries, intervention in structural heart disease, cardiovascular surgery, etc.
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