非瓣膜性心房颤动患者左心耳封堵术后心包填塞的发生及相关因素分析

王斌斌; 许祥; 王兴鹏; 李华康; 姚青; 黄海韵; 王文婷; 万陈; 刘锋; 郭燕丽; 宋治远

doi:10.16016/j.2097-0927.202312141

您当前的位置：

首页 >

文章列表页 >

非瓣膜性心房颤动患者左心耳封堵术后心包填塞的发生及相关因素分析

临床医学 | 更新时间：2026-01-09

- 非瓣膜性心房颤动患者左心耳封堵术后心包填塞的发生及相关因素分析
- Incidence and related factors of pericardial tamponade after left atrial appendage closure in patients with non-valvular atrial fibrillation
- 陆军军医大学学报 2024年46卷第7期页码：768-774
- 作者机构：
  
  1.400038 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
  2.400038 重庆, 陆军军医大学(第三军医大学)第一附属医院超声科
- 作者简介：
  
  [宋治远，E-mail: zysong2010@126.comSONG Zhiyuan, E-mail: zysong2010@126.com
- 基金信息：
- DOI：10.16016/j.2097-0927.202312141
  中图分类号： R195.4;R541.75;R654.206
- 收稿：2023-12-29，
  
  修回：2024-02-04，
  
  纸质出版：2024-04-15
- 稿件说明：
移动端阅览
王斌斌, 许祥, 王兴鹏, 等. 非瓣膜性心房颤动患者左心耳封堵术后心包填塞的发生及相关因素分析[J]. 陆军军医大学学报, 2024,46(7):768-774.

Binbin WANG, Xiang XU, Xingpeng WANG, et al. Incidence and related factors of pericardial tamponade after left atrial appendage closure in patients with non-valvular atrial fibrillation[J]. Journal of Army Medical University, 2024, 46(7): 768-774.
王斌斌, 许祥, 王兴鹏, 等. 非瓣膜性心房颤动患者左心耳封堵术后心包填塞的发生及相关因素分析[J]. 陆军军医大学学报, 2024,46(7):768-774. DOI： 10.16016/j.2097-0927.202312141.

Binbin WANG, Xiang XU, Xingpeng WANG, et al. Incidence and related factors of pericardial tamponade after left atrial appendage closure in patients with non-valvular atrial fibrillation[J]. Journal of Army Medical University, 2024, 46(7): 768-774. DOI： 10.16016/j.2097-0927.202312141.

摘要

目的

观察非瓣膜性心房颤动(nonvalvular atrial fibrillation

NVAF)患者左心耳封堵术后(left atrial appendage closure

LAAC)心包填塞(pericardial tamponade

PT)的发生率

探讨其相关因素及转归。

方法

选择2014年8月至2023年3月在我院心血管内科住院并接受LAAC治疗的1 192例NVAF患者为研究对象

通过医院病案管理系统收集患者一般临床资料、术前经胸超声心动图(transthoracic echocardiography

TTE)和经食道超声心动图(transesophageal echocardiography

TEE)检测资料、术前常规化验检查、术中资料及随访资料

根据LAAC后是否发生PT分为无PT组(

=8)和PT组(

=1 184)。统计分析PT的发生率、相关因素及转归。

结果

1 192例患者中

有男性639例(53.6%)、女性553例(46.4%)

年龄(68.10±9.65)岁

CHA

-VASc评分(4.51±1.72)分

HAS-BLED评分(3.36±1.09)分。共发生PT 8例(0.67%)

其中6例发生于LAAC后1~33 h

2例发生在LAAC后第19、27天。与无PT组比较

PT组中

TEE检测与左心耳造影测量左心耳最大口径较大(

=0.025

=0.015)

而左心耳最大深度则较小(

=0.028

=0.031)

PT组封堵器一次放置成功率较显著降低(

=0.031);PT组封堵器压缩率明显大于无PT组(

=0.046)。多因素分析结果显示

左心耳最大口径较大、左心耳平均有效深度较小、封堵器压缩率较大是发生PT的主要危险因素。8例PT患者均经停用抗栓药物、心包穿刺/手术引流后治愈。随访(39±27)个月

PT组患者未发生器械相关血栓形成(device-related thrombosis

DRT)、缺血性卒中/系统性栓塞等并发症。

结论

LAAC术后PT发生率低

其发生与左心耳口径较大、深度相对不足、封堵器压缩率较大相关

PT可经停用抗栓药物、心包穿刺/手术引流后治愈。

Abstract

Objective

To observe the incidence of pericardial tamponade (PT) after left atrial appendage closure (LAAC) in patients with non-valvular atrial fibrillation (NVAF)

and to explore its related factors and outcomes.

Methods

NVAF patients who were hospitalized and treated with LAAC in Department of Cardiology of our hospital from August 2014 to March 2023 were selected for the study.The general clinical data

preoperative transthoracic echocardiography and transesophageal echocardiography data

results of routine preoperative laboratory tests

intraoperative data and follow-up data of the patients were collected through the hospital medical record management system.The enrolled patients were classified into the non-PT group (

=8) and the PT group (

=1 184) according to whether PT occurred after LAAC or not.The incidence of PT

related risk factors and outcomes were statistically analyzed.

Results

This study included 639 males (53.6%) and 553 females (46.4%)

with an average age of 68.1±9.65 years.The CHA

-VASc

score was 4.51±1.72

and the HAS-BLED score was 3.36±1.09.PT occurred in 8 cases (0.67%)

among them

6 cases occurred 1 to 33 h after LAAC

and 2 cases occurred on day 19 and day 27 after LAAC.As for the results of transesophageal echocardiography (TEE) and LAA angiography

compared with the non-PT group

the PT group had the significantly larger maximum caliber of the LAA (

=0.025

=0.015)

smaller maximum depth of the LAA (

=0.028

=0.031)

and lower success rate of one-time placement of the occluder (

=0.031);The occluder compression rate of the PT group was significantly greater than that of the non-PT group (

=0.046).Multivariate analysis showed that larger maximum diameter of LAA

smaller average effective depth of LAA and larger compression rate of occluder were the main risk factors for PT.All the 8 PT patients were cured by stopping antithrombotic drugs

pericardiocentesis or surgical drainage.During a mean follow-up of 39±27 months

there were no device-related thrombosis (DRT)

ischemic stroke

systemic embolism and other complications in the PT group.

Conclusion

The incidence of PT after LAAC is low

which is related to the large diameter of LAA

the relatively insufficient depth of the LAA and the large compression rate of the occlude.PT can be cured by stopping antithrombotic drugs and pericardiocentesis/surgical drainage.

关键词

Keywords

references

SHI S B, TANG Y H, ZHAO Q Y, et al . Prevalence and risk of atrial fibrillation in China: a national cross-sectional epidemiological study[J ] . Lancet Reg Health West Pac, 2022, 23: 100439. DOI: 10.1016/j.lanwpc.2022.100439.

HINDRICKS G, POTPARA T, DAGRES N, et al . 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery(EACTS): the task force for the diagnosis and management of atrial fibrillation of t he European Society of Cardiology(ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC[J ] . Eur Heart J, 2021, 42(5): 373-498. DOI: 10.1093/eurheartj/ehaa612.

HOLMES D R, REDDY V Y, TURI Z G, et al . Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial[J ] . Lancet, 2009, 374(9689): 534-542. DOI: 10.1016/S0140-6736(09)61343-X.

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.

OSMANCIK P, HERMAN D, NEUZIL P, et al . Left atrial appendage closure versus direct oral anticoagulants in high-risk patients with atrial fibrillation[J ] . J Am Coll Cardiol, 2020, 75(25): 3122-3135. DOI: 10.1016/j.jacc.2020.04.067.

OSMANCIK P, HERMAN D, NEUZIL P, et al . 4-year outcomes after left atrial appendage closure versus nonwarfarin oral anticoagulation for atrial fibrillation[J ] . J Am Coll Cardiol, 2022, 79(1): 1-14. DOI: 10.1016/j.jacc.2021.10.023.

BOERSMA L V A, SCHMIDT B, BETTS T R, et al . Implant success and safety of left atrial appendage closure with the WATCHMAN device: peri-procedural outcomes from the EWOLUTION registry[J ] . Eur Heart J, 2016, 37(31): 2465-2474. DOI: 10.1093/eurheartj/ehv730.

FREEMAN J V, VAROSY P, PRICE M J, et al . The NCDR left atrial appendage occlusion registry[J ] . J Am Coll Cardiol, 2020, 75(13): 1503-1518. DOI: 10.1016/j.jacc.2019.12.040.

PRICE M J, VALDERRÁBANO M, ZIMMERMAN S, et al . Periprocedural pericardial effusion complicating transcatheter left atrial appendage occlusion: a report from the NCDR LAAO registry[J ] . Circ Cardiovasc Interv, 2022, 15(5): e011718. DOI: 10.1161/CIRCINTERVENTIONS.121.011718.

中华医学会心血管病学分会, 中华心血管病杂志编辑委员会. 中国左心耳封堵预防心房颤动卒中专家共识(2019)[J]. 中华心血管病杂志, 2019, 47(12): 937-955. DOI: 10.3760/cma.j.issn.0253?3758.2019.12.002.

Chinese Society of Cardiology of Chinese Medical Association, Editorial Board of Chinese Journal of Cardiology . 2019 Chinese Society of Cardiology(CSC) expert consensus statement on left atrial appendage closure in the prevention of stroke in patients with atrial fibrillation[J ] . Chin J Cardiol, 2019, 47(12): 937-955. DOI: 10.3760/cma.j.issn.0253?3758.2019.12.002.

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.

YAO Q, SONG Z Y, SHU M Q, et al . Clinical application of Watchman occluder for left atrial appendage occlusion[J ] . J Third Mil Med Univ, 2014, 36(20): 2129-2132.

ISOGAI T, SAAD A M, SHEKHAR S, et al . Incidence and outcomes of pericardial effusion/tamponade following percutaneous left atrial appendage closure[J ] . Am J Cardiol, 2021, 160: 126-129. DOI: 10.1016/j.amjcard.2021.08.028.

SCHMIDT B, BETTS T R, SIEVERT H, et al . Incidence of pericardial effusion after left atrial appendage closure: the impact of underlying heart rhythm-Data from the EWOLUTION study[J ] . J Cardiovasc Electrophysiol, 2018, 29(7): 973-978. DOI: 10.1111/jce.13626.

FU G H, HE B, CHU H M, et al . Delayed pericardial effusion or tamponade following left atrial appendage closure: a single-center experience[J ] . J Formos Med Assoc, 2023, 122(8): 707-713. DOI: 10.1016/j.jfma.2022.11.010.

YU Y B, CHU H M, WANG B H, et al . Pericardial effusion following percutaneous left atrial appendage closure using the LAmbre device[J ] . Front Cardiovasc Med, 2023, 10: 1188322. DOI: 10.3389/fcvm.2023.1188322.

YANG L F, ZHANG X C, JIN Q C, et al . Pericardial effusion during the perioperative period for left atrial appendage closure[J ] . Front Cardiovasc Med, 2021, 8: 678460. DOI: 10.3389/fcvm.2021.678460.

REDDY V Y, HOLMES D, DOSHI S K, et al . Safety of percutaneous left atrial appendage closure: results from the Watchman Left Atrial Appendage System for Embolic Protection in Patients with AF(PROTECT AF) clinical trial and the Continued Access Registry[J ] . Circulation, 2011, 123(4): 417-424. DOI: 10.1161/CIRCULATIONAHA.110.976449.

PRICE M J, FRIEDMAN D J, DU C, et al . Comparative safety of transcatheter LAAO with the first-generation Watchman and next-generation Watchman FLX Devices[J ] . J Am Coll Cardiol Interv, 2022, 15(21): 2115-2123. DOI: 10.1016/j.jcin.2022.09.002.

FAUCHIER L, CINAUD A, BRIGADEAU F, et al . Device-related thrombosis after percutaneous left atrial appendage occlusion for atrial fibrillation[J ] . J Am Coll Cardiol, 2018, 71(14): 1528-1536. DOI: 10.1016/j.jacc.2018.01.076.

CEPAS-GUILLÉN P, FLORES-UMANZOR E, LEDUC N, et al . Impact of device implant depth after left atrial appendage occlusion[J ] . J Am Coll Cardiol Interv, 2023, 16(17): 2139-2149. DOI: 10.1016/j.jcin.2023.05.045.

浏览量

172

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

1990—2021年全球、中国和日本心房颤动/心房扑动的疾病负担及其预测分析

外周血piR-hsa-2700592在房颤患者预后中的预测研究

外周血SNORD55对心房颤动患者预后的预测价值

泛素C末端水解酶1抑制CaMKⅡ泛素化促进心房颤动

40岁以上继发孔房间隔缺损患者介入封堵术前后心房颤动发生率与相关因素分析