China/Chinese Expert Consensus Statement on Catheter-based Left Atrial Appendage Occlusion via Minimalistic/Simplified Approach (2022)

doi:10.3877/cma.j.issn.2095-6568.2022.02.001

Abstract

Structural Heart Disease Committee of Chinese College of Cardiovascular Physicians. China/Chinese Expert Consensus Statement on Catheter-based Left Atrial Appendage Occlusion via Minimalistic/Simplified Approach (2022)[J]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2022, 10(02): 65-80.

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Figures/Tables 11

References 77

[1]	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.
[2]	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 non-inferiority trial[J]. Lancet, 2009, 374(9689):534-542.
[3]	Reddy VY, Doshi SK, Sievert H, et al. Percutaneous left atrial appendage closure for stroke prophylaxis in patients with atrial fibrillation: 2.3-Year Follow-up 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.
[4]	Reddy VY, Doshi SK, Kar S, et al. 5-Year outcomes after left atrial appendage closure: from the PREVAIL and PROTECT AF Trials[J]. J Am Coll Cardiol, 2017, 70(24):2964-2975.
[5]	Kavinsky CJ, Kusumoto FM, Bavry AA, et al. SCAI/ACC/HRS institutional and operator requirements for left atrial appendage occlusion[J]. Heart Rhythm, 2016, 13(5):e241-e250.
[6]	Guérios EE, Schmid M, Gloekler S, et al. Left atrial appendage closure with the Amplatzer cardiac plug in patients with atrial fibrillation[J]. Arq Bras Cardiol, 2012, 98(6):528-536.
[7]	陈良龙, 陆林祥, 方军, 等. 无需全身麻醉、经胸超声心动图引导的改良经皮左心耳封堵术的初步经验[J]. 中国介入心脏病学杂志, 2017, 25(06):326-330.
[8]	Wang J, Rong B, Zhang K, et al. Feasibility and safety of left atrial appendage occlusion guided by procedural fluoroscopy only: a pilot study[J]. Pacing Clin Electrophysiol, 2021, 44(7):1207-1215.
[9]	So CY, Lam YY, Cheung GS, et al. Minimalistic approach to left atrial appendage occlusion using the LAmbre device[J]. JACC Cardiovasc Interv, 2018, 11(11):1113-1114.
[10]	Yuniadi Y, Hanafy DA, Raharjo SB, et al. Left atrial appendage closure device implantation guided with fluoroscopy only: Long-term results[J]. J Arrhythm, 2019, 35(2):262-266.
[11]	Zhang X, Jin Q, Kong D, et al. Comparison of fluoroscopy and transesophageal echocardiogram for intra-procedure device surveillance assessment during implantation of Watchman[J]. Int J Cardiol, 2021, 324:72-77.
[12]	中国医师协会心血管内科医师分会结构性心脏病专业委员会. 中国经导管左心耳封堵术临床路径专家共识[J]. 中国介入心脏病学杂志, 2019, 27(12):661-672.
[13]	中华医学会心血管病学分会, 中华心血管病杂志编辑委员会. 中国左心耳封堵预防心房颤动卒中专家共识(2019)[J]. 中华心血管病杂志, 2019, 47(12):937-955.
[14]	中华医学会心电生理和起搏分会, 中国医师协会心律学专业委员会, 心房颤动防治专家工作委员会, 等. 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(2019)[J]. 中华心律失常学杂志, 2019, 23(5):372-392.
[15]	中华医学会心电生理和起搏分会, 中国医师协会心律学专业委员会, 中国房颤中心联盟心房颤动防治专家工作委员会. 心房颤动:目前的认识和治疗建议(2021)[J]. 中华心律失常学杂志, 2022, 26(1):15-88.
[16]	Glikson M, Wolff R, Hindricks G, et al. EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion - an update[J]. Europace, 2020, 22(2):184.
[17]	Saw J, Fahmy P, Spencer R, et al. Comparing measurements of CT angiography, TEE, and fluoroscopy of the left atrial appendage for percutaneous closure[J]. J Cardiovasc Electrophysiol, 2016, 27(4):414-422.
[18]	Rajwani A, Nelson AJ, Shirazi MG, et al. CT sizing for left atrial appendage closure is associated with favourable outcomes for procedural safety[J]. Eur Heart J Cardiovasc Imaging, 2017, 18(12):1361-1368.
[19]	Ruan ZB, Wang F, Chen GC, et al. A comparative study of three imaging modalities for size selection of a Watchman left atrial appendage closure device[J]. Yonsei Med J, 2022, 63(4):325-332.
[20]	Romero J, Husain SA, Kelesidis I, et al. Detection of left atrial appendage thrombus by cardiac computed tomography in patients with atrial fibrillation: a meta-analysis[J]. Circ Cardiovasc Imaging, 2013, 6(2):185-194.
[21]	吴大虎, 张波, 田为中, 等. 基于心脏CT血管造影的三维形态学分析在左心耳封堵术中的应用[J]. 中国医学影像学杂志, 2022, 30(3):279-284.
[22]	Korsholm K, Berti S, Iriart X, et al. Expert recommendations on cardiac computed tomography for planning transcatheter left atrial appendage occlusion[J]. JACC Cardiovasc Interv, 2020, 13(3):277-292.
[23]	Rajiah P, Alkhouli M, Thaden J, et al. Pre- and Postprocedural CT of transcatheter left atrial appendage closure devices[J]. Radiographics, 2021, 41(3):680-698.
[24]	Tilz RR, Potpara T, Chen J, et al. Left atrial appendage occluder implantation in Europe: indications and anticoagulation post-implantation. Results of the European Heart Rhythm Association Survey[J]. Europace, 2017, 19(10):1737-1742.
[25]	Zhang X, Jin Q, Kong D, et al. Clinical outcomes of bivalirudin versus heparin in atrial fibrillation patients undergoing percutaneous left atrial appendage occlusion[J]. Ann Transl Med, 2021, 9(8):629.
[26]	Ostermayer SH, Reisman M, Kramer PH, et al. Percutaneous left atrial appendage transcatheter occlusion (PLAATO system) to prevent stroke in high-risk patients with non-rheumatic atrial fibrillation: results from the international multi-center feasibility trials[J]. J Am Coll Cardiol, 2005, 46(1):9-14.
[27]	金沁纯, 张晓春, 孔德红,等. 经三维食道超声心动图定量测量左心耳(LAA)周长在左心耳封堵术中的应用价值[J]. 复旦学报(医学版), 2019, 46(6):769-775.
[28]	Kar S, Doshi SK, Sadhu A, et al. Primary outcome evaluation of a next-generation left atrial appendage closure device: results from the PINNACLE FLX Trial[J]. Circulation, 2021, 143(18):1754-1762.
[29]	Ellis CR, Jackson GG, Kanagasundram AN, et al. Left atrial appendage closure in patients with prohibitive anatomy: Insights from PINNACLE FLX[J]. Heart Rhythm, 2021, 18(7):1153-1161.
[30]	Della Rocca DG, Magnocavallo M, Gianni C, et al. Procedural and short-term follow-up outcomes of Amplatzer Amulet occluder versus Watchman FLX device: a meta-analysis[J]. Heart Rhythm, 2022, 19(6):1017-1018.
[31]	Kapadia S. Late-breaking study results reinforce positive real-world outcomes with the WATCHMAN FLX™ LAAC Device[EB/OL]. [2022-06-27]. URL
[32]	Caro-Codón J, Galeote G, López-Fernández T, et al. Close relationship between circumflex artery and left atrial appendage[J]. Rev Port Cardiol, 2015, 34(10):627-628.
[33]	Xiao F, Chen Y, Chen Y, et al. Delayed pericardial effusion after left atrial appendage closure with the LAmbre device: Importance of a fully open umbrella[J]. J Cardiovasc Electrophysiol, 2021, 32(6):1646-1654.
[34]	Boersma LV, Schmidt B, Betts TR, et al. Implant success and safety of left atrial appendage closure with the WATCHMAN device: peri-procedural outcomes from the EWOLUTION registry[J]. Eur Heart J, 2016, 37(31):2465-2474.
[35]	Fountain RB, Holmes DR, Chandrasekaran K, et al. The PROTECT AF (WATCHMAN left atrial appendage system for embolic PROTECTion in patients with atrial fibrillation) trial[J]. Am Heart J, 2006, 151(5):956-961.
[36]	Waksman R, Pendyala LK. Overview of the Food and Drug Administration circulatory system devices panel meetings on WATCHMAN left atrial appendage closure therapy[J]. Am J Cardiol, 2015, 115(3):378-384.
[37]	Boersma LV, Ince H, Kische S, et al. Evaluating real-world clinical outcomes in atrial fibrillation patients receiving the WATCHMAN left atrial appendage closure technology: Final 2-eear outcome data of the EWOLUTION trial focusing on history of stroke and hemorrhage[J]. Circ Arrhythm Electrophysiol, 2019, 12(4):e006841.
[38]	Reddy VY, Möbius-Winkler 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.
[39]	Li X, Jin Q, Zhang X. Closure device-related thrombosis after anticoagulation with dabigatran in patients undergoing percutaneous left atrial appendage closure: case reports and literature review[J]. Front Pharmacol, 2020, 11:563920.
[40]	Li X, Zhang X, Jin Q, et al. Clinical efficacy and safety comparison of rivaroxaban and dabigatran for nonvalvular atrial fibrillation patients undergoing percutaneous left atrial appendage closure operation[J]. Front Pharmacol, 2021, 12:614762.
[41]	Li X, Zhang X, Jin Q, et al. The impact of dabigatran and rivaroxaban on variation of platelet activation biomarkers and DRT following percutaneous left atrial appendage closure[J]. Front Pharmacol, 2021, 12:723905.
[42]	Bai Y, Xue X, Duenninger E, et al. Real-world survival data of device-related thrombus following left atrial appendage closure: 4-year experience from a single center[J]. Heart Vessels, 2019, 34(8):1360-1369.
[43]	白元, 秦永文, 黄新苗. LACbes(R)左心耳封堵系统结构特征与应用要点[J]. 介入放射学杂志, 2021, 30(8):851-855.
[44]	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.
[45]	Yu J, Liu X, Zhou J, et al. Long-term safety and efficacy of combined percutaneous LAA and PFO/ASD closure: a single-center experience (LAAC combined PFO/ASD closure)[J]. Expert Rev Med Devices, 2019, 16(5):429-435.
[46]	姜小飞, 朱卫民, 李军, 等. 经皮左心耳封堵联合冠状动脉介入"一站式"治疗对心房颤动合并冠心病患者的安全性及疗效初探[J]. 中国心血管病研究, 2019, 17(1):73-77.
[47]	Regoli F, Araco M, Moccetti T, et al. Potential clinical utility and feasibility of combined left atrial appendage closure and positioning of miniaturized pacemaker through a single right femoral vein access[J]. Am J Cardiol, 2017, 120(2):236-242.
[48]	Attinger-Toller A, Maisano F, Senn O, et al. "One-Stop Shop": safety of combining transcatheter aortic valve replacement and left atrial appendage occlusion[J]. JACC Cardiovasc Interv, 2016, 9(14):1487-1495.
[49]	Wintgens L, Romanov A, Phillips K, et al. Combined atrial fibrillation ablation and left atrial appendage closure: long-term follow-up from a large multicentre registry[J]. Europace, 2018, 20(11):1783-1789.
[50]	Phillips KP, Pokushalov E, Romanov A, et al. Combining Watchman left atrial appendage closure and catheter ablation for atrial fibrillation: multicentre registry results of feasibility and safety during implant and 30 days follow-up[J]. Europace, 2018, 20(6):949-955.
[51]	Korsholm K, Jensen JM, Nielsen-Kudsk JE. Cardiac computed tomography for left atrial appendage occlusion: acquisition, analysis, advantages, and limitations[J]. Interv Cardiol Clin, 2018, 7(2):229-242.
[52]	Reddy VY, Holmes D, Doshi SK, et al. Safety of percutaneous left atrial appendage closure: results from the Watchman Left Atrial Appendage System for Embolic Protection in Patients with AF (PROTECT AF) clinical trial and the Continued Access Registry[J]. Circulation, 2011, 123(4):417-424.
[53]	Reddy VY, Gibson DN, Kar S, et al. Post-approval U.S. experience with left atrial appendage closure for stroke prevention in atrial fibrillation[J]. J Am Coll Cardiol, 2017, 69(3):253-261.
[54]	Lam YY, Yip GW, Yu CM, et al. Left atrial appendage closure with AMPLATZER cardiac plug for stroke prevention in atrial fibrillation: initial Asia-Pacific experience[J]. Catheter Cardiovasc Interv, 2012, 79(5):794-800.
[55]	Phillips KP, Santoso T, Sanders P, et al. Left atrial appendage closure with WATCHMAN in Asian patients: 2 year outcomes from the WASP registry[J]. Int J Cardiol Heart Vasc, 2019, 23:100358.
[56]	Sievert H, Lesh MD, Trepels T, et al. Percutaneous left atrial appendage transcatheter occlusion to prevent stroke in high-risk patients with atrial fibrillation: early clinical experience[J]. Circulation, 2002, 105(16):1887-1889.
[57]	Yang L, Zhang X, Jin Q, et al. Pericardial effusion during the perioperative period for left atrial appendage closure[J]. Front Cardiovasc Med, 2021, 8:678460.
[58]	Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC[J]. Eur Heart J, 2021, 42(5):373-498.
[59]	Du X, Chu H, He B, et al. Optimal combination strategy of left atrial appendage closure plus catheter ablation in a single procedure in patients with nonvalvular atrial fibrillation[J]. J Cardiovasc Electrophysiol, 2018, 29(8):1089-1095.
[60]	Mo BF, Sun J, Zhang PP, et al. Combined therapy of catheter ablation and left atrial appendage closure for patients with atrial fibrillation: a case-control study[J]. J Interv Cardiol, 2020, 2020:8615410.
[61]	Chen M, Wang ZQ, Wang QS, et al. One-stop strategy for treatment of atrial fibrillation: feasibility and safety of combining catheter ablation and left atrial appendage closure in a single procedure[J]. Chin Med J (Engl), 2020, 133(12):1422-1428.
[62]	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.
[63]	Webb G, Gatzoulis MA. Atrial septal defects in the adult: recent progress and overview[J]. Circulation, 2006, 114(15):1645-1653.
[64]	Mas JL, Derumeaux G, Guillon B, et al. Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke[J]. N Engl J Med, 2017, 377(11):1011-1021.
[65]	Saver JL, Carroll JD, Thaler DE, et al. Long-term outcomes of patent foramen ovale closure or medical therapy after stroke[J]. N Engl J Med, 2017, 377(11):1022-1032.
[66]	Wang JM, Zhu XY, Sheng XT, et al. Simultaneous transcatheter closure of the left atrial appendage and congenital interatrial communication closure[J]. Congenit Heart Dis, 2022, 17(1):61-69.
[67]	姜小飞, 曾杰, 卢聪, 等. 左心耳封堵联合房间隔缺损封堵“一站式”治疗对房间隔缺损合并心房颤动患者的安全性及疗效观察[J]. 中国心血管病研究, 2020, 18(1):10-14.
[68]	崔春生, 王建铭, 朱鲜阳, 等. 左心耳封堵术治疗先天性心脏病合并房颤临床观察[J]. 临床军医杂志, 2016, 44(10):1087-1089,1091.
[69]	姜小飞, 钟林涛, 王坤, 等. 房间隔缺损或卵圆孔未闭联合左心耳一站式封堵治疗的安全及有效性[J]. 岭南心血管病杂志, 2021, 27(1):36-41.
[70]	崔春生, 王建铭, 朱鲜阳, 等. 左心耳封堵术治疗先天性心脏病合并房颤临床观察[J]. 临床军医杂志, 2016, 44(10):1087-1089,1091.
[71]	刘毅, 刘海涛, 武峰, 等. 房间隔联合左心耳封堵治疗房间隔缺损伴心房颤动老年患者1例[J]. 心脏杂志, 2017, 29(1):21-23.
[72]	Jiang X, Zeng J, Zhong L, et al. Preliminary study on the safety and efficacy of one-stop treatment of percutaneous LAAO combined with coronary intervention for higher risk of bleeding in Patients with AF complicated with CHD[J]. Heart Surg Forum, 2021, 24(3):E474-E478.
[73]	Okutucu S, Sayin BY, Aksoy H, et al. Leadless pacemaker implantation in a patient with percutaneous mitral repair and left atrial appendage occlusion: a crowded heart[J]. Am J Cardiol, 2018, 121(8): e55.
[74]	Tsai YC, Phan K, Munkholm-Larsen S, et al. Surgical left atrial appendage occlusion during cardiac surgery for patients with atrial fibrillation: a meta-analysis[J]. Eur J Cardiothorac Surg, 2015, 47(5):847-854.
[75]	Martín Gutiérrez E, Castaño M, Gualis J, et al. Beneficial effect of left atrial appendage closure during cardiac surgery: a meta-analysis of 280 585 patients[J]. Eur J Cardiothorac Surg, 2020, 57(2):252-262.
[76]	王宇彬, 宋光远, 张海彤, 等. 经导管主动脉瓣置换术后心房颤动行左心耳封堵术二例[J]. 中国循环杂志, 2019, 34(2):196-197.
[77]	左海润, 徐承义, 苏唏, 等. "一站式"经导管主动脉瓣置换术联合左心耳封堵术一例[J]. 华西医学, 2021, 36(9):1315-1317.

项目	经典式LAAO	简化式LAAO
推荐人群	存在以下情况之一者： 1.严重脊柱畸形 2.心脏先天性或后天性畸形（严重心脏转位、异位心等） 3.左心血液极度淤滞者 4.认知障碍、精神异常等 5.复杂左心耳解剖（多分叶、反鸡翅等）	1. 全身情况良好；术前评估提示心脏及左心耳解剖不复　杂；能较好配合局部麻醉手术 2. 尤其适合：口咽部及上消化道疾病导致TEE不能配合　或多次失败者；麻醉高风险或存在麻醉禁忌
TEE术前评估	＋	＋
MSCT术前评估	＋/-	＋/-
麻醉方式	全身静脉麻醉（采用导尿管、气管插管、有创血压监测、心电图）	局部麻醉（袖带血压监测、指尖氧饱和度监测、心电图）
TEE术中引导与评估	＋	-
TTE术中引导与评估	-	＋
X线透视	＋	＋
多角度左心耳造影	＋	＋
器械型号选择标准	X线透视/TEE/CT	X线透视
封堵效果评估	TEE/X线透视	X线透视
术后患者管理	CCU或普通病房在监护下麻醉苏醒，需要留置导尿，住院　时间长	普通病房，无需留置导尿，住院时间短

项目	经典式LAAO	简化式LAAO
推荐人群	存在以下情况之一者： 1.严重脊柱畸形 2.心脏先天性或后天性畸形（严重心脏转位、异位心等） 3.左心血液极度淤滞者 4.认知障碍、精神异常等 5.复杂左心耳解剖（多分叶、反鸡翅等）	1. 全身情况良好；术前评估提示心脏及左心耳解剖不复　杂；能较好配合局部麻醉手术 2. 尤其适合：口咽部及上消化道疾病导致TEE不能配合　或多次失败者；麻醉高风险或存在麻醉禁忌
TEE术前评估	＋	＋
MSCT术前评估	＋/-	＋/-
麻醉方式	全身静脉麻醉（采用导尿管、气管插管、有创血压监测、心电图）	局部麻醉（袖带血压监测、指尖氧饱和度监测、心电图）
TEE术中引导与评估	＋	-
TTE术中引导与评估	-	＋
X线透视	＋	＋
多角度左心耳造影	＋	＋
器械型号选择标准	X线透视/TEE/CT	X线透视
封堵效果评估	TEE/X线透视	X线透视
术后患者管理	CCU或普通病房在监护下麻醉苏醒，需要留置导尿，住院　时间长	普通病房，无需留置导尿，住院时间短

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