A Single-center Retrospective Analysis Of The Safety And Efficacy Of LAAO In Patients With Nonvalvular Atrial Fibrillation

Objective:To evaluate the safety and efficacy of left atrial appendage occlusion(LAAO)in patients with nonvalvular atrial fibrillation(NVAF).Methods:76 NVAF patients treated with LAAO in The First Affiliated Hospital Of Guangxi Medical University from March 2018 to March 2021 were selected retrospectively.The success rate of operation and perioperative complications were analyzed to evaluate the safety of operation,the incidence of out-of-hospital adverse events was followed up,and the results of echocardiographic review were analyzed to understand the changes of cardiac parameters before and after operation to evaluate the effectiveness of operation.Results:76 patients with NVAF underwent LAAO under general anesthesia(11.8%)or local anesthesia(88.2%),and 71 patients successfully implanted the occluder(93.4%),and the success rate of general anesthesia and local anesthesia was 88.9% and 94%,respectively,with no significant difference(P > 0.05).And2 patients(2.6%)of perforation of left atrial appendage and acute pericardial tamponade during operation,1 patient with coronary artery spasm(1.3%),1patient(1.3%)of occluding device falling off after operation,2 patients(2.6%)of pseudoaneurysm after operation,and no serious complications such as massive hemorrhage and operation-related death during the remaining perioperative period.Among them,49 patients were LAAO combined with radiofrequency ablation(RFCA)of atrial fibrillation.Among the patients with perioperative complications,2 patients were treated with only-LAAO and 4 patients with LAAO combined with RFCA(P>0.05).65 patients were followed up for(15.0±9.1)months after operation,and 1 patient(1.5%)died of unknown cause in the other hospital,1 patient(1.5%)had thrombus on the surface of the left atrial appendage occluder,1 patient(1.5%)had massive hemoptysis,and there was no cerebral hemorrhage,massive hemorrhage of digestive tract and thromboembolism.During the follow-up,the left atrial diameter(LAD)decreased[(42±7)mm:(45±7)mm,P=0.003],and the left ventricular ejection fraction(LVEF)increased [(67±6)%:(63±9)%,P=0.014],but the left atrial transverse diameter(LATD)[(48±7)mm:(49±8)mm,P > 0.05] and left ventricular end diastolic diameter(LVEDd)[(51±4)mm:(52±5)mm,P>0.05] did not increase significantly after operation.Further analysis showed that LVEDd [(50±5)mm:(53±5)mm,P=0.01] in only-LAAO patients decreased significantly after operation,but there was no significant change after LAD and LVEF.In LAAO+RFCA,LAD decreased significantly [(41±6)mm:(44±6)mm,P=0.009],LVEDd increased [(67±6)%:(63±10)%,P=0.049] after operation,but there was no significant difference in LATD and LVEDd.Conclusion:It is safe and effective to use LAAO in NVAF patients under local anesthesia.Meanwhile,among our subjects,LAAO combined with RFCA does not increase the incidence of perioperative complications,and can improve the left atrial structure and LVEF,which may be bring more benefits to patients in the long term.