Table2_Feasibility and safety of the direct current cardioversion at the time of left atrial appendage occlusion for patients with atrial fibrillation.xlsx

BackgroundWith an increasing number of patients undergoing left atrial appendage occlusion (LAAO), more attention is being paid to relieving clinical symptoms and improving the quality of life of these patients. For patients with atrial fibrillation (AF), direct current cardioversion (DCCV) is an alternate, nonpharmacological choice to restore sinus rhythm and relieve clinical symptoms.
ObjectivesThe purpose of this study was to assess the feasibility and safety of the DCCV at the time of LAAO for patients with AF.
MethodsForty patients were enrolled in the DCCV group undergoing the DCCV at the time of LAAO. The control group undergoing LAAO alone was formed by 1:1 matching.
ResultsIn the DCCV group, cardioversion was immediately successful in 30 (75%) patients, of which 12 (40%) had AF recurrence at the three-month follow-up. The failed-DCCV group was older (73.70 ± 4.74 vs. 62.20 ± 9.01 years old, P = 0.000), had a faster postcardioversion heart rate (88.80 ± 16.58 vs. 70.97 ± 14.73 times, P = 0.03), and had a higher mean HAS-BLED score (4.00 vs. 3.00, P = 0.01) than the successful-DCCV group. No patients experienced periprocedural pericardial effusion, occluder displacement, device embolism, or >5 mm peridevice leakage. One patient experienced a transient ischemic attack (TIA) in the DCCV group during the follow-up.
ConclusionsThe DCCV at the time of LAAO is feasible and safe for AF patients with contraindications for catheter ablation or AF recurrence after previous catheter ablation to restore the sinus rhythm and relieve clinical symptoms. The DCCV at the time of LAAO is more likely to succeed for younger patients and patients with lower HAS-BLED scores.

背景：随着接受左心耳封堵术（left atrial appendage occlusion, LAAO）的患者数量持续增长，临床对缓解此类患者临床症状、提升其生活质量的关注度与日俱增。对于心房颤动（atrial fibrillation, AF）患者，直流电复律（direct current cardioversion, DCCV）是一种可选的非药物治疗手段，可用于恢复窦性心律并改善临床症状。
研究目标：本研究旨在评估心房颤动患者在接受左心耳封堵术同期行直流电复律的可行性与安全性。
研究方法：本研究纳入40例同期接受左心耳封堵术与直流电复律的患者作为直流电复律组；通过1:1匹配法，选取仅接受左心耳封堵术的患者作为对照组。
研究结果：直流电复律组中，30例（75%）患者实现即刻复律成功，其中12例（40%）在3个月随访时出现心房颤动复发。与复律成功亚组相比，复律失败亚组患者年龄更大（73.70±4.74岁 vs 62.20±9.01岁，P=0.000），复律后心率更快（88.80±16.58次/分 vs 70.97±14.73次/分，P=0.03），且平均HAS-BLED评分更高（4.00分 vs 3.00分，P=0.01）。两组均未出现围手术期心包积液、封堵器移位、装置栓塞或围装置渗漏＞5mm的情况。随访期间，直流电复律组仅1例患者发生短暂性脑缺血发作（transient ischemic attack, TIA）。
研究结论：对于存在导管消融禁忌证或既往导管消融后复发心房颤动的患者，左心耳封堵术同期行直流电复律可安全恢复窦性心律、缓解临床症状，该治疗方案具备可行性。此外，年龄较轻、HAS-BLED评分较低的患者，其直流电复律成功的概率更高。