摘要 目的观察左心房自发显影(LA SEC)的非瓣膜性心房颤动(NVAF)患者行经皮左心耳封堵(LAAC)的安全性和有效性。方法连续入选2018年7月至2019年6月在宁波市第一医院心内科住院接受经皮LAAC的NVAF患者95例,根据术前经食道超声心动图(TEE)检查结果分为无LA SEC组(n=61)和LA SEC组(n=34),通过收集围手术期并发症,术后45 d复查TEE,记录封堵器表面血栓(DRT)情况,随后规范随访观察患者卒中及出血事件发生情况,比较两组患者行LAAC的安全性及有效性。结果无LA SEC组平均左心房内径小于LA SEC组[(44.0±7.4)mm比(47.3±6.6)mm,P=0.033],其余基线资料两组差异均无统计学意义。入选患者均成功植入Watchman左心耳封堵器,围手术期两组患者均未出现死亡、一过性脑缺血发作(TIA)/脑卒中、器械栓塞及大出血事件等严重并发症。术后45 d两组分别有55例(90.2%)和31例(91.2%)完成TEE检查,无LA SEC组未发现DRT,LA SEC组出现2例(6.5%),但两组差异无统计学意义(P=0.127)。两组患者分别平均随访(12.3±3.8)个月和(12.9±3.3)个月,均无死亡事件。两组TIA/脑卒中、大出血事件及小出血事件等发生率差异均无统计学意义(均P>0.05)。结论LA SEC的NVAF患者行经皮LAAC是安全、有效的,但术后DRT发生率稍高。 Objective To investigate the safety and efficacy of percutaneous left atrial appendage closure(LAAC)in nonvalvular atrial fibrillation patients(NVAF)with left atrial spontaneous echocardiographic contrast(LA SEC).Methods A total of 95 NVAF patients treated in the Department of Cardiology of Ningbo First Hospital from July 2018 to June 2019 were enrolled in this study.The study population was divided into two group according to the presence or absence of LA SEC detected by transesophageal echocardiography(TEE).TEE was scheduled 45 days post-procedure to detect device-related thrombus(DRT).Stroke and bleeding events were recorded during follow-up.Periprocedural complications and follow-up results were compared between the two groups.Results LA diameters were smaller in non-LA SEC group than LA SEC group((44.0±7.4)mm vs(47.3±6.6)mm,P=0.033).Watchman device was successfully implanted into all the enrolled patients.No death,transient ischemic attack(TIA)/stroke,device embolization and major bleeding events occurred.Fifty patients(90.2%)in LA SEC group and 31 patients(91.2%)in non-LA SEC group finished TEE follow-up 45 days post-procedure.No device-related thrombus was detected in non-LA SEC group,while 2 cases(6.5%)were detected in LA SEC group,but there was no significant differences in the incidence between the two groups(P=0.127).The LA SEC group and non-LA SEC group were followed-up for(12.3±3.8)months and(12.9±3.3)months,respectively;and there was no significant differences in the incidence of death,TIA/stroke,major and minor bleeding events between two groups during the follow-up(all P>0.05).Conclusion LAAC in NVAF patients with LA SEC was safe and effective.However,the incidence of DRT was slightly higher.
出处 《中华医学杂志》 CAS CSCD 北大核心 2021年第13期950-955,共6页 National Medical Journal of China
基金 宁波市科学技术局社会发展重大专项(2016C50010)。
关键词 心房颤动 左心房自发显影 经皮左心耳封堵术 Atrial fibrillation Percutaneous left atrial appendage closure Left atrial spontaneous echocardiographic contrast
分类号 R54 [医药卫生—心血管疾病]
