2018 年第 1 期 第 13 卷

左心耳封堵用于心房颤动患者脑卒中二级预防的有效性和安全性

Efficacy and safety of percutaneous left atrial appendage occlusion for secondary stroke prevention in patients with atrial fibrillation

作者：蒋超张妍李松南左嵩闻松男白融杜昕董建增马长生

英文作者：Jiang Chao Zhang Yan Li Songnan Zuo Song Wen Songnan Bai Rong Du Xin Dong Jianzeng Ma Changsheng

单位：100029首都医科大学附属北京安贞医院心内科国家心血管疾病临床医学研究中心

英文单位：Corresponding author: Ma Changsheng Email: chshma@vip.sina.com

关键词：心房颤动脑卒中左心耳封堵

英文关键词：Atrialfibrillation；Stroke；Leftatrialappendageocclusion

• 摘要：

• 【摘要】目的    评价左心耳封堵术用于心房颤动患者脑卒中二级预防的有效性和安全性。方法    纳入2014年3月至2017年6月在首都医科大学附属北京安贞医院行左心耳封堵术且有既往脑卒中病史的非瓣膜性心房颤动患者26例，收集患者临床资料进行回顾性分析。术后45 d及3、6、12个月进行常规随访，此后每6个月随访1次。有效性终点为缺血性脑卒中、系统性栓塞及心血管死亡组成的复合终点，安全性终点包括大出血事件及手术相关严重并发症。结果    术中完全封堵左心耳23例，3例患者存在少量残余分流。围术期1例患者出现严重并发症，为新发缺血性脑卒中。中位随访时间12（6，24）个月，有2例患者发生缺血性脑卒中，未出现系统性栓塞及心血管死亡事件，有效性终点事件发生率为6.0/100人年。患者在随访期间未出现大出血事件，仅1例患者出现手术相关严重并发症，安全性终点事件发生率为3.0/100人年。结论    左心耳封堵可以安全有效地应用于心房颤动患者脑卒中的二级预防，可作为抗凝治疗的替代方案。

• Efficacy and safety of percutaneous left atrial appendage occlusion for secondary stroke prevention in patients with atrial fibrillation

  Jiang Chao, Zhang Yan, Li Songnan, Zuo Song, Wen Songnan, Bai Rong, Du Xin, Dong Jianzeng, Ma Changsheng

  Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing 100029, China

  Corresponding author: Ma Changsheng, Email: chshma@vip.sina.com

  【Abstract】Objective     To assess the ef cacy and safety of percutaneous left atrial appendage occlusion(LAAO) for secondary stroke prevention in patients with atrial fibrillation. Methods    From March 2014 to June 2017, a total of 26 non-valvular atrial fibrillation patients with previous ischemic stroke or transient ischemic attack who underwent LAAO in Beijing Anzhen Hospital, Capital Medical University were included. All patients were followed up at 45 d, 3, 6, and 12 months after the procedure, and every 6 months thereafter. Efficacy was assessed by a composite endpoint of ischemic stroke, systemic embolism, and cardiovascular death. Composite endpoint for safety consisted of major bleeding and serious procedure-related complications. Results    Complete closure of the left atrial appendage was achieved in 23 patients, and 3 patients had minimal residual flow. Procedure-related stroke occurred in 1 patient. After a median follow-up of 12(6,24)months, 2 patients suffered from ischemic strokes, and no systemic embolism or cardiovascular death was observed. The efficacy event rate was 6.0/100 patient-years. No major bleeding occurred during follow-up, and 1 patient had serious procedure-related complication. The safety event rate was 3.0/100 patient-years. Conclusion    LAAO is a safe and effective method for the prevention of thromboembolism in atrial fibrillation patients with previous ischemic stroke or transient ischemic attack, providing an alternative strategy to chronic anticoagulation therapy.

  【Key words】Atrial fibrillation；Stroke；Left atrial appendage occlusion

  【Fund program】National Natural Science Foundation of China（81370290, 81470464, 81500254, 81530016）; Key Research Project of Precision Medicine in National Key Research and Development Plan（2016YFC0900900）; Beijing Science and Technology Project（D151100002215004）; Beijing High Level Innovation and Entrepreneurship Support Program（G03060026）