2025 年第 5 期 第 20 卷

极简式左心耳封堵术联合导管消融术一站式治疗非瓣膜性心房颤动的安全性与有效性研究

Study on the safety and efficacy of minimally invasive left atrial appendage closure combined with catheter ablation in one-stop treatment of non-valvular atrial fibrillation

作者：陈浩然何原

英文作者：Chen Haoran He Yuan

单位：广东医科大学附属医院心血管疾病研究室，湛江524000 陈浩然现工作于广东省茂名市人民医院心血管内科

英文单位：Cardiovascular Disease Research Laboratory of Guangdong Medical University Affiliated Hospital Zhanjiang 524000 China Chen Haoran is currently working in the Department of Cardiology Maoming People′s Hospital Guangdong Province

关键词：非瓣膜性心房颤动；极简式左心耳封堵术；导管消融术；安全性；有效性

英文关键词：Non-valvularatrialfibrillation;Minimallyinvasiveleftatrialappendageclosure;Catheterablation;Safety;Effectiveness

• 摘要：

• 目的 探讨极简式左心耳封堵术（LAAC）联合导管消融术（CA）一站式治疗非瓣膜性心房颤动（NVAF）的安全性与有效性。方法 回顾性分析2022年8月至2023年7月在广东省茂名市人民医院心血管内科接受极简式LAAC联合CA一站式治疗（一站式组，20例）及仅接受CA治疗（单消融组，22例）的NVAF患者。收集并分析2组基线资料、手术过程、围手术期并发症、术后口服药物情况及12个月随访结果。结果 一站式组缺血性脑卒中史比例、CHA2DS2-VASc评分及HAS-BLED评分、左心房前后径均高于/大于单消融组，差异均有统计学意义（均P＜0.05）。在围手术期并发症方面，一站式组出现了1例假性动脉瘤血管并发症和2例鼻出血，2组均未发生心包积液以及脑卒中事件。2组术后口服单种药物情况比较差异有统计学意义（P=0.038）。一站式组复发心房颤动3例、出血事件1例，无脑卒中；单消融组无复发心房颤动、出血事件及脑卒中。有3例患者在术后3个月时出现小于3 mm的残余分流，无患者出现大于5 mm的残余分流。结论 极简式LAAC联合CA一站式手术适合高血栓栓塞和出血风险患者。一站式手术简化流程、降低风险，不依赖经食管超声心动图，提高可操作性和安全性，与单纯CA手术相当，并可能在高风险患者中效果更佳。

• Objective To investigate the safety and efficacy of minimally invasive left atrial appendage closure (LAAC) combined with catheter ablation (CA) in one-stop treatment of non-valvular atrial fibrillation (NVAF). Methods From August 2022 to July 2023, patients with NVAF who underwent one-stop minimally invasive LAAC combined with CA (one-stop group, 20 cases) and only CA (single ablation group, 22 cases) in the Department of Cardiology, Maoming People′s Hospital, Guangdong Province were retrospectively analyzed. The baseline data, surgical procedures, perioperative complications, postoperative medications and 12-month follow-up results were collected and analyzed. Results The proportion of ischemic stroke history, CHA2DS2-VASc score, HAS-BLED score, left atrial anteroposterior diameter in the one-stop group were higher than those in the single ablation group (all P＜0.05). In terms of perioperative complications, there was 1 case of pseudoaneurysm vascular complication and 2 cases of epistaxis in the one-stop group, and no pericardial effusion and stroke events occurred in the two groups. There was significant difference in the oral administration of single drug between the two groups (P=0.038). In the one-stop group, there were 3 cases of recurrent atrial fibrillation, 1 case of bleeding event, and no stroke. There were no recurrent atrial fibrillation, bleeding events and stroke in the single ablation group. Three patients had a residual shunt less than 3 mm at 3 months after surgery, and no patient had a residual shunt greater than 5 mm. Conclusions  Minimally invasive LAAC combined with CA one-stop procedure is suitable for patients with high risk of thromboembolism and bleeding. One-stop procedure simplifies the procedure, reduces the risk, does not rely on transesophageal echocardiography, improves operability and safety, and is equivalent to simple CA surgery, and may be more effective in high-risk patients.