| Background and objectives:The main harm of AF is to increase the risk of stroke by 5-6 times and the risk of death by twice.Warfarin has been the standard treatment for the prevention of AF stroke in the past 50 years.New oral anticoagulants(NOAC)have been proved to be superior to or even better than warfarin in preventing AF stroke,and it is convenient to take without monitoring and the interaction between drugs is less,The side effects of intracranial hemorrhage are low,which is an alternative to warfarin.Left atrial appendage closure(LAAC)has been proved to be effective and safe in preventing stroke in people with atrial fibrillation.A randomized controlled study,PROTECT-AF,showed that the efficacy of watchman LAAC in preventing stroke,embolism,cardiovascular death and all-cause death in patients with nonvalvular atrial fibrillation(NVAF)was not inferior to warfarin.On this basis,someone proposed a combined procedure of atrial fibrillation catheter ablation(CA)and LAAC,and gradually carried out in major centers.As the application of NOAC after ablation of atrial fibrillation is more and more common,combined therapy of CA and LAAC is gradually accepted by people.However,there is no combined therapy compared with new oral anticoagulants in people with catheter ablation of atrial fibrillation in the world,The efficacy and safety of combined therapy and new oral anticoagulants in patients with atrial fibrillation undergoing catheter ablation may be different from that of randomized controlled trials with strictly controlled conditions.Therefore,it is necessary to adopt rigorous statistical processing to compare the efficacy and safety of the two treatment measures on the basis of strict screening of patients.Methods:People with NVAF who underwent one-stop surgical treatment or took NOAC after CA for atrial fibrillation in the department of cardiology of our hospital from January 1,2018 to December 30,2019 were selected as the research objects according to strict inclusion and exclusion criteria.The propensity score was used to match the two groups.The incidence of perioperative and postoperative adverse events was observed and recorded to evaluate the effectiveness and safety of the two treatment measures.Results:After propensity score matching,62 pairs of patients were matched.The procedures were successfully performed in all the patients.There were 3 cases(4.8%)of procedure-related complications in the combined treatment group,including one puncture site bleeding,one subcutaneous hematoma and one pericardial effusion.The difference was not significant(4.8%vs.3.2%,P=0.652).After a mean follow-up of 18±2.5 months,42 patients in the combined treatment group and 44 patients in the CA group maintained sinus rhythm(67.7 vs 71.0%,P=0.067).Among them,2 cases(3.2%)in the combined group and 1 case(1.6%)in the latter were ablated again due to recurrence of atrial fibrillation.There were one bleeding event,one ischemic stroke and one device related complications(occluder surface thrombosis)in the one-stop treatment group;there were two bleeding events and one ischemic stroke in the CA group,and the incidence of adverse events was similar between the two groups(4.8 vs 4.8%,P=0.632).Conclusion:The combination of AF-CA and LAAC is efficacious and safe... |
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