Safety And Efficacy On Percutaneous Left Atrial Appendage Occlusion To Prevent Atrial Fibrillation Patients From Stroke:23 Cases Analysis

Objective: Atrial fibrillation is a very common arrhythmia.The most primary complication of atrial fibrillation is thromboembolism in important parts of human body,of which the most common and harmful is stroke.More than 90% of left atrial thrombus in patients with non-valvular atrial fibrillation and 60% of stroke embolus in patients with rheumatic valvular disease are caused by left atrial appendage.Although warfarin is the main treatment for prevention from atrial fibrillation thromboembolism,it may increase the risk of bleeding,needs monitoring of INR regularly,has narrow therapeutic window and appears interactions with other drugs and food.While new oral anticoagulants are expensive with uncertain compliance,increasing risk of leakage suit and lack of antagonists,and part of the patients exist anticoagulant contraindicated.In recent years,several large clinical studies confirmed that percutaneous left atrial appendage occlusion(PLAAO)can effectively reduce the incidence of stroke caused by atrial fibrillation.As there are few domestic studies about the follow-up of PLAAO,this paper aims to explore its efficiency and safety by observing its clinical effect and relative examinations.Methods: 23 patients who underwent LAA closure with the Watchman device between August 2014 and December 2015 were eligible.To make select and abandon standard,we collected clinical data,CHA2DS2-VASC score and HASBLED score before surgery.Then through Mimics three-dimensional imaging technology we rebuilt the left atrial appendage structure of patients with atrial fibrillation and applied 3D printing technology to print LAA model.Follow-up examinations were performed after 3 days,1 months,3 months,6 months,and 1 year and thereafter annually.Afterward,alternating office visits and telephone follow-up were performed every 6 months.Results : During a mean follow-up period of 9.1±5.0 months,the mean age was 68.5±11.4 years,and 47.83% were women.24 hours after surgery,the rates of puncture vascular complications,the postoperative residual shunt,hydro pericardium,pulmonary infection and the occurrence of atrial arrhythmia were 4.35%,17.39%,21.74%,21.74% and 8.70% respectively.In the follow-up period,all consecutive patients are alive and the rates of hospitalization and the bleeding were 21.74% and 17.39% respectively.Routine test of blood,liver and kidney function,UCG results compared with preoperative has no obvious difference(P > 0.05),and no serious MACE and complications.Conclusion: LAA closure with the Watchman device is safe and feasible for stroke protection in patients with atrial fibrillation.