经皮左心耳封堵联合冠脉介入“一站式”治疗对房颤合并冠心病患者的安全性及疗效初探

目的 探讨对非瓣膜性房颤合并冠心病的患者，同期进行经皮左心耳封堵术联合冠脉介入一站式治疗的可行性、安全性及疗效。方法 回顾性分析珠海市人民医院2017年4月-2018年6月收治的5例房颤合并冠心病的患者的临床资料。所有患者术后采用阿司匹林100mg Qd+氯吡格雷75mg Qd双抗1年，阿司匹林/波立维单抗长期使用的方案。术后即刻评价左心耳封堵及冠脉介入疗效，并于术后45天，90天随访观察左心耳封堵器的位置、血栓形成以及残余分流情况及患者临床表现。结果 5例患者均成功植入WATCHMAN左心耳封堵器及冠脉支架。术后即刻封堵效果满意，WATCHMAN封堵器符合PASS原则，冠脉介入治疗效果满意。术中无器械表面血栓，无心包填塞及血管并发症。随访结果显示，5例患者无出现脑卒中、心功能恶化者、封堵器移位、封堵器残余分流加重及器械表面血栓、心绞痛或心梗事件，且亦未发现皮肤瘀斑、消化道出血、脑出血等出血事件。结论 对非瓣膜性房颤合并冠心病患者，同期实施左心耳封堵术联合冠脉介入一站式治疗的安全性可，有一定的可行性，近、中期的随访效果良好。

Preliminary study on the safety and efficacy of one-stop treatment of percutaneous left atrial appendage occlusion combined with coronary intervention for patients with atrial fibrillation complicated with coronary heart disease

Objective To explore the feasibility, safety and efficacy of one-stop treatment of percutaneous left atrial appendage occlusion combined with coronary intervention for patients with non-valvular atrial fibrillation complicated with coronary heart disease. Methods Retrospectively analyzing the clinical data of 5 patients with atrial fibrillation combined with coronary heart disease admitted from Zhuhai People''s Hospital from April 2017 to June 2018. After the operation, all the patients were treated with aspirin 100 mg Qd and clopidogrel 75 mg Qd for 1 year, a long-term use of aspirin/clopidogrel. The effects of left atrial appendage occlusion and coronary intervention were evaluated immediately each time. The location of left atrial appendage occluder, thrombosis and residual leak, and clinical manifestations were observed during follow-up for 45 days and 90 days. Results Five patients were successfully implanted with WATCHMANTM device and coronary stents. After the operation, the immediate sealing effect was satisfactory. The WATCHMANTM occluder was in accordance with the PASS principle, and the coronary intervention was satisfactory. During operation, there was no device-related thrombosis, no tamponade and vascular complications. Follow-up results showed that in 5 patients there were no hemorrhagic stroke, worsening heart function, device dislocation, slubber residual leak and device-related thrombosis, angina pectoris or myocardial infarction, and no skin ecchymosis, gastrointestinal bleeding, cerebral hemorrhage. Conclusion For patients with non-valvular atrial fibrillation combined with coronary heart disease, the safety and feasibility of one-stop treatment with left atrial appendage and coronary intervention can be reliable, the short and medium term follow up of curative effect were also satisfactory.