A Single-Center Clinical Study Of Percutaneous Left Atrial Appendage Occlusure In Patients With Nonvalvular Atrial Fibrillation

Objective: To evaluate the safety and efficacy of percutaneous left atrial appendage closure(LAAC)in patients with nonvalvular atrial fibrillation.Methods: The clinical data were collected from January 2019 to December 2021 from patients with atrial fibrillation who underwent LAAC in the Department of Cardiology,Second Hospital of Lanzhou University.The clinical data of the patients were retrospectively analyzed,including the occurrence of perioperative complications,the occurrence of adverse events in the patients during the follow-up period,the occurrence of device-related thrombus(DRT)and peri-device leakage(PDL),the changes of postoperative cardiac function and structure-related indexes,the patients’ postoperative antithrombotic therapy,etc.The perioperative complications of patients include pericardial effusion or cardiac tamponade,intracoronary air embolism,occluder displacement or fall-off,bleeding,and esophageal injury caused by catheter ablation combined with LAAC "one-stop" procedure,etc.The adverse events in patients during follow-up included ischemic stroke,thromboembolism at other sites,severe bleeding,severe pericardial effusion,and all-cause death.At the same time,the differences in the occurrence of related events between different surgical methods and types of occluders were compared.To evaluate the safety and efficacy of LAAC,in order to provide a reference for further optimizing the management strategy of LAAC.Result:(1)A total of 195 patients were included in this study,143 patients underwent simple LAAC and 52 patients underwent one-stop procedure.The patient’s surgical success rate was 99.5%,the perioperative complication rate was 1.5%.The patient had no ischemic stroke events and the incidence of other adverse events in patients was 2.6% during the follow-up.The recurrence rate of atrial fibrillation was26.9% in patients after one-stop procedure.There was no significant difference in the incidence of events related to the two surgical methods(P>0.05).(2)The number of patients receiving regular antithrombotic therapy was 67.7% during the follow-up.The incidence of DRT,thromboembolism,severe bleeding and death events in patients was 1.5%,0,1.0% and 1.0% respectively.(3)The left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDd)and left ventricular end-systolic diameter(LVEDs)of patients after LAAC were not significantly changed compared with those before operation(P>0.05).The left atrial diameter(LAd)of patients after LAAC was reduced compared with that before operation(P<0.05).(4)The postoperative rehospitalization rate of patients was 15.5%,including 19% in the the simple LAAC group and 5.8% in the one-stop group.Compared with simple LAAC,patients had a lower rehospitalization rate after one-stop procedure.The difference between groups was statistically significant(P<0.05).(5)The incidence of postoperative DRT and PDL in patients was 1.6% and 17.5% respectively.The incidence of PDL ≤3 mm,PDL >3 mm and ≤5 mm,PDL >5 mm was 13.9%,2.6% and 1.0% respectively.The incidence of DRT for two types of LAA occluders,plug and disc,was 1.5% and 0 respectively and the incidence of PDL for two types of occluders was 20.7% and 8.5% respectively.There was no statistically significant difference between groups(P>0.05).Conclusions:(1)LAAC has high safety and efficacy for stroke prevention in patients with nonvalvular atrial fibrillation.The incidences of perioperative complications and adverse events were similar between simple LAAC and one-stop procedure.(2)The cardiac function and structure of patients with LAAC have no significant changes compared to the preoperative.(3)The incidence of DRT was similar for both plug and disc types of LAA occluders.Compared with disc occluder,the incidence of PDL in plug occluder is higher.