导管射频消融联合左心耳封堵治疗持续性心房颤动１例

目的 探讨导管射频消融联合左心耳封堵治疗持续性心房颤动的可行性及安全性。 方法 对1例血栓栓塞及出血风险都很高、存在心悸及气促症状的长程持续性心房颤动患者实施导管射频消融后立即进行左心耳封堵,观察手术即刻效果、并发症,术后华法林抗凝45 d,改为阿司匹林、氯吡格雷双联抗血小板,随访3月,观察症状改善情况、出血及血栓事件。 结果 成功同期实施导管射频消融联合左心耳封堵术,术中无心包填塞等并发症,术后随访未发作心悸、气促,左心耳封堵器未见血栓及残余分流,双联抗血小板期间出现牙龈出血,停用阿司匹林后未再出血。 结论 对符合适应证的持续性心房颤动患者实施导管射频消融联合左心耳封堵治疗是可行及安全的。

Catheter Radiofrequency Ablation in Combination with Left Atrial AppendageClosure for Persistent Atrial Fibrillation( one case report)

Objective To investigate the feasibility and safety of radiofrequency catheter ablation combined with left atrial appendage occlusion for the treatment of persistent atrial fibrillation. Methods A persistent atrial fibrillation patient with high risk of thromboembolism and bleeding, suffering from palpitations and short breath, underwent left atrial appendage closure following radiofrequency catheter ablation, and the outcomes and complications were observed. After the procedure, anticoagulation with warfarin was given for 45 days followed by dual antiplatelet therapy with aspirin and clopidogrel. The patient was followed-up for 3 months to observe the improvement of symptoms, bleeding and thrombotic events. Results We succeeded in the implementation of catheter radiofrequency catheter ablation combined with left atrial appendage occlusion. No pericardial effusion or other intraoperative complications were observed. During the follow-up, the patient presented no palpitations, short breath, left atrial appendage occluder thrombus, or residual shunt. Gingival bleeding occured during dual antiplatelet therapy and was stopped when aspirin discontinued. Conclusion It is feasible and safe for patients with persistent atrial fibrillation to receive the combinational therapy of radiofrequency catheter ablation and left atrial appendage occlusion when there are interventional indications.