How to balance the risks and benefits of left atrial appendage closure?

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How to balance the risks and benefits of left atrial appendage closure?

Expert Reviews | 更新时间：2026-01-09

- How to balance the risks and benefits of left atrial appendage closure?
- Journal of Third Military Medical University Vol. 41, Issue 19, Pages: 1851-1854(2019)
- 作者机构：
  
  400038 重庆，陆军军医大学(第三军医大学)第一附属医院心血管内科，重庆市介入心脏病学研究所
- 作者简介：
- 基金信息：
  
  the Science and Technology Project of Social Undertakings and People's Livelihood Security of Chongqing(CSTC2016shms-ztzx10001-3)
- DOI：10.16016/j.1000-5404.201908074
  CLC： R541.75;R619
- Received：12 August 2019，
  
  Revised：2019-09-02，
  
  Published：15 October 2019
- 稿件说明：
移动端阅览
Zhiyuan SONG. How to balance the risks and benefits of left atrial appendage closure?[J]. Journal of Third Military Medical University, 2019, 41(19): 1851-1854.
DOI：

Zhiyuan SONG. How to balance the risks and benefits of left atrial appendage closure?[J]. Journal of Third Military Medical University, 2019, 41(19): 1851-1854. DOI： 10.16016/j.1000-5404.201908074.

摘要

左心耳封堵术(left atrial appendage closure

LAAC)是预防非瓣膜性房颤(non-valvular atrial fibrillation

NVAF)患者缺血性卒中的新技术，其临床疗效与安全性已被公认，并被国内外相关指南推荐。然而，LAAC的临床获益与风险并存，如何权衡LAAC的风险与获益是当今临床关注的重要问题之一。本述评从多中心临床随机对照研究入手，较系统地阐述了LAAC在预防NVAF患者缺血性卒中方面的循证医学证据；并对LAAC并发症的发生率及主要并发症进行了叙述；提出了“降低风险、增加获益”的具体举措。

Abstract

Left atrial appendage closure (LAAC) is a new technique to prevent ischemic stroke in patients with non-valvular atrial fibrillation (NVAF)

and recommended by international and domestic guidelines due to its confirmed efficacy and safety in clinical practice. However

its benefits have always been coexisting with some risks. So

how to balance the risks and benefits is one of the important issues concerned by clinical professionals. Based on randomized clinical trials

this manuscript systematically introduces the evidence-based medicine of LAAC in preventing ischemic stroke with NVAF patients

elucidates incidence of complications and major complications of LAAC

then puts forward specific measurement of reducing risks and increasing benefits in clinical practice.

关键词

Keywords

references

KIRCHHOF P, BENUSSI S, KOTECHA D, et al . 2016 ESC Guidelines for themanagement of atrial fibrillation developed in collaboration with EACTS[J ] . Eur Heart J, 2016, 37(38): 2893-2962. DOI:10.1093/eurheartj/ehw210.

JANUARY C T, WANN L S, CALKINS H, et al . 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: A report of the American college of cardiology/American heart association task force on clinical practice guidelines and the heart rhythm society in collaboration with the society of thoracic surgeons[J ] . Circulation, 2019, 140(2): e125-e151. DOI:10.1161/CIR.0000000000000665.

黄从新, 张澍, 黄德嘉, 等.心房颤动:目前的认识和治疗建议(2018)[J].中华心律失常学杂志, 2018, 22(4) : 279-346. DOI: 10.3760/cma.j.issn.1007-6638.2018.04.002.

HUANG C X, ZHANG S, HUANG D J, et al . Atrial fibrillation: current understanding and treatment recommendations-2018[J ] . Chin J Cardiac Arrhyth, 2018, 22(4) : 279-346. DOI: 10.3760/cma.j.issn.1007-6638.2018.04.002.

姚青, 宋治远, 舒茂琴, 等. Watchman左心耳封堵器的临床应用[J].第三军医大学学报, 2014, 36(20): 2129-2132. DOI:10.16016/j.1000-5404.2014.20.002.

YAO Q, SONG Z Y, SHU M Q, et al . Clinical applicationof Watchman occluder for left atrial appendage occlusion[J ] . J Third Mil Med Univ, 2014, 36(20): 2129-2132. DOI:10.16016/j.1000-5404.2014.20.002.

REDDY V Y, SIEVERT H, HALPERIN J, et al . Percutaneous left atrial appendage closure vs warfarin for atrial fibrillation: a randomized clinical trial[J ] . JAMA, 2014, 312(19): 1988-1998. DOI:10.1001/jama.2014.15192.

HOLMES D R Jr, KAR S, PRICE M J, et al . Prospective randomized evaluation of the Watchman Left Atrial Appendage Closure device in patients with atrial fibrillation versus long-term warfarin therapy: the PREVAIL trial[J ] . J Am Coll Cardiol, 2014, 64(1): 1-12. DOI:10.1016/j.jacc.2014.04.029.

REDDY V Y, DOSHI S K, KAR S, et al . 5-year outcomes after left atrial appendage closure: from the PREVAIL and PROTECT AF trials[J ] . J Am Coll Cardiol, 2017, 70(24): 2964-2975. DOI:10.1016/j.jacc.2017.10.021.

BOERSMA L V, INCE H, KISCHE S, et al . Efficacy and safety of left atrial appendage closure with WATCHMAN in patients with or without contraindication to oral anticoagulation: 1-Year follow-up outcome data of the EWOLUTION trial[J ] . Heart Rhythm, 2017, 14(9): 1302-1308. DOI:10.1016/j.hrthm.2017.05.038.

BOERSMA L V, INCE H, KISCHE S, et al . Evaluating real-world clinical outcomes in atrial fibrillation patients receiving the WATCHMAN left atrial appendage closure technology. Final 2-year outcome data of the EWOLUTION trial focusing on history of stroke and hemorrhage[J ] . Circ Arrhythm Electrophysiol, 2019, 12:e006841. DOI:10.1161/CIRCEP.118.006841.

REDDY V Y, MÖBIUS-WINKLER S, MILLER M A, et al . Left atrial appendage closure with the watchman device in patients with a contraindication for oral anticoagulation: the ASAP study (ASA plavix feasibility study with watchman left atrial appendage closure technology)[J ] . J Am Coll Cardiol, 2013, 61(25): 2551-2556. DOI:10.1016/j.jacc.2013.03.035.

SHARMA D, REDDY V Y, SANDRI M , et al . Left atrial appendage closure in patients with contraindications to oral anticoagulation[J ] . J Am Coll Cardiol, 2016, 67(18): 2190-2192. DOI:10.1016/j.jacc.2016.02.053.

SICK P B, SCHULER G, HAUPTMANN K E, et al . Initial worldwide experience with theWATCHMAN left atrial appendage system for stroke prevention in atrial fibrillation[J ] . J Am Coll Cardiol, 2007, 49(13): 1490-1495. DOI:10.1016/j.jacc.2007.02.035.

PARK J W, BETHENCOURT A, SIEVERT H, et al . Left atrial appendage closure with Amplatzer cardiac plug in atrial fibrillation: initial European experience[J ] . Catheter Cardiovasc Interv, 2011, 77(5): 700-706. DOI:10.1002/ccd.22764.

REDDY V Y, GIBSON D N, KAR S, et al . Post-approval US experience with left atrial appendage closure for stroke prevention in atrial fibrillation[J ] . J Am Coll Cardiol, 2017, 69(3): 253-261. DOI:10.1016/j.jacc.2016.10.010.

姚青, 宋治远, 郭燕丽, 等.经皮左心耳封堵术在非瓣膜性心房颤动患者中的应用——单中心经验[J].中国介入心脏病学杂志, 2018, 26(10):553-558. DOI:10. 3969/j.issn.1004-8812.2018.10.004.

YAO Q, SONG Z Y, GUO Y L, et al . Application of left atrial appendage occlusion in patients with nonvalvular atrial fibrillation : experience of one center[J ] . Chin J Inte rv Cardiol, 2018, 26(10):553-558. DOI: 10.3969/j.issn.1004-8812.2018.10.004.

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