Abstract:Atrial fibrillation(AF) as one kind of arrhythmias has gained the most attention clinically and the greatest progress in evidencebased medicine at present. Besides the therapies such as anticoagulant therapy and ventricular rate control, catheter ablation(energy sources including radiofrequency and freezing) is the first choice of treatment recommended by guidelines at present from the perspective of symptom control. However, its effectiveness in preventing against cardiac apoplexy has not been authorized yet. The technique of percutaneous left atrial appendage occlusion fills the blank and becomes one of the better choices for AF patients who are highrisky of stroke and intolerance of permanent anticoagulant therapy. The derivative “onestop treatment of AF” thereof has become one of hot topics of current industry. This paper discusses the methodology of the “onestop treatment of AF” and advances of its curative effect.
杜先锋, 储慧民. “房颤一站式治疗”的方法学与疗效评估[J]. 实用心电学杂志, 2017, 26(3): 212-217.
DU Xian-Feng, CHU Hui-Min. The methodology and efficacy evaluation of “one-stop treatment of atrial fibrillation”. JOURNAL OF PRACTICAL ELECTROCARDIOLOGY, 2017, 26(3): 212-217.
[1] January CT,Wann LS,Alpert JS,et al.2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society[J]. J Am Coll Cardiol,2014,64(21): e1-e76.[2] Kirchhof P,Benussi S,Kotecha D,et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS[J].Europace,2016,18(11): 1609-1678.[3] Verma A,Champagne J,Sapp J,et al.Discerning the incidence of symptomatic and asymptomatic episodes of atrial fibrillation before and after catheter ablation (DISCERN AF): a prospective, multicenter study[J]. JAMA Intern Med,2013,173(2): 149-156.[4] Tilz RR,Rillig A,Thum AM,et al. Catheter ablation of longstanding persistent atrial fibrillation: 5year outcomes of the Hamburg Sequential Ablation Strategy[J]. J Am Coll Cardiol,2012,60(19): 1921-1929.[5] Hirsh BJ,CopelandHalperin RS,Halperin JL. Fibrotic atrial cardiomyopathy, atrial fibrillation, and thromboembolism: mechanistic links and clinical inferences[J].J Am Coll Cardiol,2015,65(20): 2239-2251.[6] Marrouche NF,Wilber D,Hindricks G,et al. Association of atrial tissue fibrosis identified by delayed enhancement MRI and atrial fibrillation catheter ablation: the DECAAF study[J]. JAMA,2014,311(5): 498-506.[7] Mahnkopf C,Badger TJ,Burgon NS,et al. Evaluation of the left atrial substrate in patients with lone atrial fibrillation using delayedenhanced MRI: implications for disease progression and response to catheter ablation[J]. Heart Rhythm,2010,7(10): 1475-1481.[8] Ezekowitz MD,Nagarakanti R,Noack H,et al. Comparison of dabigatran and warfarin in patients with atrial fibrillation and valvular heart disease: the RELY trial (randomized evaluation of longterm anticoagulant therapy)[J]. Circulation,2016,134(8): 589-598.[9] Nieuwlaat R,Capucci A,Camm AJ,et al. Atrial fibrillation management: a prospective survey in ESC member countries: the Euro Heart Survey on Atrial Fibrillation[J]. Eur Heart J,2005,26(22): 2422-2434.[10] Go AS,Hylek EM,Chang Y,et al. Anticoagulation therapy for stroke prevention in atrial fibrillation: how well do randomized trials translate into clinical practice?[J].JAMA,2003,290(20): 2685-2692.[11] Zhou Z,Hu D. An epidemiological study on the prevalence of atrial fibrillation in the Chinese population of mainland China[J]. J Epidemiol,2008,18(5): 209-216.[12] Wang ZZ,Du X,Wang W,et al. Longterm persistence of newly initiated warfarin therapy in chinese patients with nonvalvular atrial fibrillation[J]. Circ Cardiovasc Qual Outcomes,2016,9(4): 380-387.[13] Gallagher AM,Rietbrock S,Plumb J,et al. Initiation and persistence of warfarin or aspirin in patients with chronic atrial fibrillation in general practice: do the appropriate patients receive stroke prophylaxis?[J]. J Thromb Haemost,2008,6(9): 1500-1506.[14] Wolf PA,Abbott RD,Kannel WB.Atrial fibrillation: a major contributor to stroke in the elderly. The Framingham Study[J]. Arch Intern Med,1987,147(9):1561-1564.[15] Blackshear JL,Odell JA. Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation[J].Ann Thorac Surg,1996,61(2):755-759.[16] Melduni RM,Schaff HV,Lee HC,et al. Impact of left atrial appendage closure during cardiac surgery on the occurrence of early postoperative atrial fibrillation, stroke, and mortality: a propensity scorematched analysis of 10 633 patients[J].Circulation,2017,135(4):366-378.[17] Gillinov AM,Gelijns AC,Parides MK,et al. Surgical ablation of atrial fibrillation during mitralvalve surgery[J].N Engl J Med,2015,372(15):1399-1409.[18] Reddy VY,Doshi SK,Sievert H,et al. Percutaneous left atrial appendage closure for stroke prophylaxis in patients with atrial fibrillation: 2.3year followup of the PROTECT AF (Watchman left atrial appendage system for embolic protection in patients with atrial fibrillation) Trial[J]. Circulation,2013,127(6): 720-729.[19] Reddy VY,Sievert H,Halperin J,et al. Percutaneous left atrial appendage closure vs warfarin for atrial fibrillation: a randomized clinical trial[J]. JAMA,2014,312(19): 1988-1998.[20] Holmes DR,Reddy VY,Turi ZG,et al. Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised noninferiority trial[J]. Lancet,2009,374(9689): 534-542. [21] Reddy VY,MbiusWinkler S,Miller MA,et al. Left atrial appendage closure with the Watchman device in patients with a contraindication for oral anticoagulation: the ASAP study (ASA plavix feasibility study with Watchman left atrial appendage closure technology)[J]. J Am Coll Cardiol,2013,61(25): 2551-2556.[22] Holmes DR,Kar S,Price MJ,et al. Prospective randomized evaluation of the Watchman left atrial appendage closure device in patients with atrial fibrillation versus longterm warfarin therapy: the PREVAIL trial[J]. J Am Coll Cardiol,2014,64(1): 1-12.[23] Reddy VY,Akehurst RL,Armstrong SO,et al. Time to costeffectiveness following stroke reduction strategies in AF: warfarin versus NOACs versus LAA closure[J]. J Am Coll Cardiol,2015,66(24): 2728-2739.[24] 黄从新.左心耳干预预防心房颤动患者血栓栓塞事件:目前的认识和建议[J].中华心律失常学杂志,2014,18(6): 401-415. [25] Swaans MJ,Post MC,Rensing BJ,et al. Ablation for atrial fibrillation in combination with left atrial appendage closure: first results of a feasibility study[J]. J Am Heart Assoc,2012,1(5): e002212.[26] Calvo N,Salterain N,Arguedas H,et al. Combined catheter ablation and left atrial appendage closure as a hybrid procedure for the treatment of atrial fibrillation[J].Europace,2015,17(10): 1533-1540.[27] Heeger CH,Rillig A,Lin T,et al. Feasibility and clinical efficacy of left atrial ablation for the treatment of atrial tachyarrhythmias in patients with left atrial appendage closure devices[J]. Heart Rhythm,2015,12(7): 1524-1531.[28] Phillips KP,Walker DT,Humphries JA. Combined catheter ablation for atrial fibrillation and Watchman left atrial appendage occlusion procedures: fiveyear experience[J].J Arrhythm,2016,32(2): 119-126.[29] Romanov A,Pokushalov E,Artemenko S,et al. Does left atrial appendage closure improve the success of pulmonary vein isolation? Results of a randomized clinical trial[J]. J Interv Card Electrophysiol,2015,44(1): 9-16.[30] Fassini G,Conti S,Moltrasio M,et al. Concomitant cryoballoon ablation and percutaneous closure of left atrial appendage in patients with atrial fibrillation[J].Europace,2016,18(11): 1705-1710.