Clinical Follow-up Results And Analysis Of Patients With NVAF After Percutaneous Left Atrial Appendage Occlusion

Objective:To evaluate the safety and effectiveness of percutaneous left atrial appendage occlusion.Methods:Patients who received percutaneous left atrial appendage occlusion in the Department of Cardiology,the First Hospital of Jilin University from February2017 to December 2020 and completed postoperative outpatient follow-up were included.Clinical history data of the patients were collected,and preoperative routine examination,transthoracic echocardiography and transesophageal echocardiography were completed.After the occlusion of the left atrial appendage,the occurrence of instrument peeling,myocardial infarction,stroke,vascular approach related complications,bleeding events,pericardial effusion,emergency cardiac surgery,and death events during the perioperative period（<7days）were observed.Outpatient follow-up was completed at 1 month,3 months,6 months and 1 year after surgery,and follow-up was conducted once a year.Patients were recorded for surgical adverse events,device thrombosis,systemic embolism,ischemic stroke,TIA,hemorrhagic stroke,skin and mucosal bleeding,and cardiovascular death events.Current medication was used,and TEE/TTE and ECG were reexamined.Results:（1）A total of 56 patients who underwent percutaneous left atrial appendage occlusion in the Department of Cardiology,First Hospital of Jilin University and completed postoperative outpatient follow-up were included in this study.Among them,there were 17 females and 39 males with an average age of65.4±9.6（37-81）years.There were 24 cases of paroxysmal atrial fibrillation and32 cases of persistent atrial fibrillation.There were 8 cases of congestive heart failure/left ventricular dysfunction,42 cases of hypertension,20 cases of diabetes,32 cases of stroke/TIA/thromboembolism,and 23 cases of vascular disease.CHA₂DS₂-VASc score 3.9±1.6,HAS-BLED score 2.3±1.0.（2）All the 56 patients with NVAF received left atrial appendage occlusion and Watchman occlusion device was used.8 patients received left atrial appendage occlusion,20 patients received one-stop left atrial appendage occlusion combined with cryo-balloon ablation,and 28 patients received one-stop left atrial appendage occlusion combined with radiofrequency ablation.The occlusion was successful in 56 patients,and the success rate was100%.Intraoperative transesophageal echocardiography and angiography revealed no residual shunt in 55 patients and a little residual shunt in 1 patient.（3）Complications occurred in 2 patients（2 patients）during the perioperative period（<7d）.In 1 case,the CHA₂DS₂-VASc score was 5 points,and the HAS-BLED score was 4 points.Right femoral artery pseudoaneurysm occurred after surgery.After resection of right femoral artery pseudoaneurysm and arterial repair,the patient was discharged from the hospital after improvement.In the other case,the CHA₂DS₂-VASc score was 7 points,and the HAS-BLED score was 3 points.After the adjustment of anticoagulant drugs,the monitoring of hemoglobin and urine routine showed no further bleeding,and the patient was discharged from hospital after improvement.（4）All patients were followed up for more than 1 month,with a mean follow-up of 20.0±12.8 months and a median follow-up of 19.0 months.No stroke,device thrombosis,systemic embolism,surgical adverse events or TIA occurred during follow-up.One patient with a small amount of residual shunt after the operation disappeared after reexamination of transesophageal echocardiography 1 month after the operation.Patients with a total of 1 event,CHA₂DS₂-VASc score 2 points,HAS-BLED score 1 minute,postoperative warfarin therapy during petechiae appeared skin ecchymosis,switch to the cutting class treatment,after review not seen bleeding symptoms.Conclusions:In this study,a total of 56 patients with NVAF underwent left atrial appendage occlusion,and occlusion was successful in all patients,with a surgical success rate of 100%.The incidence of perioperative adverse events was 3.6%（2/56）,and the incidence of bleeding events during follow-up was 1.8%（1/56）.No serious adverse events such as emergency cardiac surgery or cardiovascular death.During the follow-up period,there were no adverse events such as new device thrombosis,ischemic stroke,TIA,systemic embolism,etc.,suggesting that left atrial appendage occlusion is effective as an intervention to prevent stroke.