Safety and effectiveness of left atrial appendage occlusion in patients with atrial fibrillation and end-stage renal disease undergoing long-term hemodialysis.
10.3760/cma.j.cn112148-20210608-00487
- VernacularTitle:长期透析的终末期肾病合并心房颤动患者行左心耳封堵术的安全性与有效性初探
- Author:
Wen Li DAI
1
;
Ke Xin YAO
1
;
Chao JIANG
1
;
Ran YANG
1
;
Song Nan LI
1
;
De Yong LONG
1
;
Chang Qi JIA
1
;
Xu LI
1
;
Jia Hui WU
1
;
Xin DU
1
;
Jian Zeng DONG
1
;
Chang Sheng MA
1
Author Information
1. Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
- Publication Type:Journal Article
- MeSH:
Aged;
Aged, 80 and over;
Atrial Appendage/surgery*;
Atrial Fibrillation/surgery*;
Echocardiography, Transesophageal;
Humans;
Kidney Failure, Chronic/therapy*;
Male;
Middle Aged;
Renal Dialysis;
Stroke;
Thromboembolism;
Treatment Outcome
- From:
Chinese Journal of Cardiology
2021;49(9):880-885
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To evaluate the safety and effectiveness of left atrial appendage occlusion (LAAO) in patients with atrial fibrillation and end-stage renal disease undergoing long-term hemodialysis. Methods: Six patients with AF and end-stage renal disease(ESRD)on long term hemodialysis who underwent LAAO from March 2017 to March 2021 in Beijing Anzhen Hospital were enrolled. Baseline characteristics such as age, sex, types of arrhythmia, stroke and bleeding score, and continuous dialysis time were collected. Four patients underwent LAAO, two patients underwent the combined procedure of catheter ablation and LAAO. Perioperative treatment and serious complications were recorded. Transesophageal echocardiography was repeated at 45 days and 60 days after the procedure. Telephone follow-up was conducted at 3, 6 and 12 months after the procedure, and every 6 months thereafter. Thromboembolism and major bleeding events and survival were evaluated. Results: The average age was (66.7±17.0) years old, and 5 were male (5/6). There were 4 patients with paroxysmal AF (4/6), and 2 patients with persistent AF (2/6). The mean CHA2DS2-VASc score was (4.8±1.5), and the HAS-BLED score was (3.5±1.4). The duration of hemodialysis was 2.6 (1.1, 8.3) years. Successfully Watchman implantation was achieved in all patients. There were no severe perioperative complications, and no device related thrombosis or leaks were observed by transesophageal echocardiography. During a mean of 22.0 (12.0, 32.0) months follow-up, there was no thromboembolism or major bleeding events. A total of 2 patients died, one from sudden cardiac death, and another one from heart failure. Conclusions: LAAO may be a safe and effective therapeutic option for prevention of thromboembolism in patients with atrial fibrillation and end-stage renal disease undergoing long-term hemodialysis, further studies with larger patient cohort are needed to confirm our results.
