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目的导管消融无法完全去除心房颤动(简称房颤)患者的卒中风险。而近期左心耳封堵已在预防房颤卒中方面显示出一定的优势。本研究的目的在于明确联合左心耳封堵与导管消融治疗高危卒中阵发性房颤患者的可行性。方法本研究共入选了28例卒中风险高危的阵发性房颤患者,其中男性17例,女性11例,年龄(75.9±4.3)岁。房颤病史(5.3±3.9)年。CHA2DS2-VASc评分(5.4±1.5)。所有患者都有卒中史,轻者仅表现为一过性脑缺血发作,重者表现为大面积脑梗死。术前3天内完成经食管超声心动图(TEE)检查,排除左房内血栓。导管消融的术式是环肺静脉线性消融,终点为完成双侧肺静脉的电隔离;随即于左心耳内植入Lefort封堵器。术后45天内口服华法林(或新型口服抗凝药)+阿司匹林+氯吡格雷,随后服阿司匹林+氯吡格雷至6个月,之后长期维持口服阿司匹林。于第3、6、12、18、24个月时随访心律状态及卒中再发的情况。结果所有患者均成功完成了导管消融+左心耳封堵术。随访(12.9±3.2)个月,有24例患者维持窦性心律。无一例患者再发卒中。仅1例患者出现轻微的心包渗液,未行特殊处理自行吸收。结论对于卒中风险高危的房颤患者,同时行导管消融及左心耳封堵是可行的,且安全、有效。
The purpose of catheter ablation can not completely remove the risk of stroke in patients with atrial fibrillation (AF). The recent closure of the left atrial appendage has shown some advantages in the prevention of atrial fibrillation stroke. The purpose of this study was to determine the feasibility of combined left atrial appendage occlusion and catheter ablation in the treatment of patients with paroxysmal atrial fibrillation in high-risk stroke. Methods A total of 28 patients with paroxysmal atrial fibrillation who were at high risk of stroke were enrolled. Among them, 17 were male and 11 were female, with an average age of 75.9 ± 4.3 years. Atrial fibrillation history (5.3 ± 3.9) years. CHA2DS2-VASc score (5.4 ± 1.5). All patients had a history of stroke, light only showed transient ischemic attack, severe cases showed large areas of cerebral infarction. Transesophageal echocardiography (TEE) was performed within 3 days before surgery to exclude left atrial thrombi. Catheter ablation is a circumferential pulmonary vein ablation, the end point to complete the bilateral pulmonary vein electrical isolation; then left atrial appendage Lefort occluder. Oral warfarin (or new oral anticoagulant) + aspirin + clopidogrel 45 days postoperatively followed by aspirin + clopidogrel for 6 months followed by long-term oral aspirin maintenance. At the 3rd, 6th, 12th, 18th and 24th months, the status of rhythm and the recurrence of stroke were observed. Results All patients successfully completed catheter ablation + left atrial appendage occlusion. Follow-up (12.9 ± 3.2) months, 24 patients maintained sinus rhythm. None of the patients had a second stroke. Only 1 patient showed mild pericardial effusion, without special treatment to absorb. Conclusions In patients with atrial fibrillation at high risk of stroke, simultaneous catheter ablation and left atrial appendage occlusion are feasible and safe and effective.