ZHAO Zhihong,WANG Saihua,LUO Jun,et al.Clinical characteristics of device-related thrombus after left atrial appendage closure combined with cryoballoon ablation in patients with atrial fibrillation[J].同济大学学报（医学版）,2022,43(1):56-62. [点击复制]
Clinical characteristics of device-related thrombus after left atrial appendage closure combined with cryoballoon ablation in patients with atrial fibrillation
(Department of Cardiology, Zhoupu Hospital, Shanghai University of Medicine & Health Science, Shanghai 201318, China)
Abstract:
Objective To explore the characteristics of device-related thrombus(DRT) after left atrial appendage closure(LAAC) combined with second-generation balloon cryoablation in high stroke-risk patients with non-valvular atrial fibrillation(AF). Methods From January 2018 to June 2019, a total of 130 high stroke-risk patients with non-valvular AF(72 males and 58 females, mean age 71.5±8.9, left atrial anteroposterior diameter 45.1±7.8 mm) whom underwent LAAC combined with second-generation balloon cryoablation were included. The proportions of paroxysmal AF, persistent AF and long-term persistent AF were 63.8%, 13.8% and 22.3%, respectively. The CHA2DS2-VASc and HAS-BLED scores were 5.0±1.7 and 2.8±1.0 respectively. Thirty nine patients(30.2%) had a history of ischemic stroke or transient ischemic attacks(TIA); 23 patients(17.7%) were post-PCI. Postoperative antithrombotic regimen was conventional warfarin or non-vitamin K antagonist oral anticoagulants(NOACs). Transesophageal echocardiography(TEE) review 2-3 months after operation, according to TEE results patients were classified as DRT group or non-DRT group(control group). Clinical characteristics of patients in DRT group were analyzed, and antithrombotic therapy regimen was adjusted, the clinical outcomes were analyzed during the follow-up. Results All 130 patients with AF completed LAAC combined with second-generation balloon cryoablation of pulmonary vein electrical isolation; and patients were followed up for a median of 16 months(12-21 months). In all cases, the LAAC was completed by TEE monitoring during the operation; 106 cases were implanted with Watchman occluders and 24 cases with LAmbre occluders. Ninety cases(69%) completed TEE review, and 7 cases(5.4%) diagnosed with DRT, including 5 implanted Watchman and 2 implanted LAmbre review occluders. Three cases showed hypoechoic mass and 1 case showed fascicular floc-like hypoechoic mass, and 3 cases showed local roughness on the upper side of the umbrella surface. During follow-up, sinus rhythm was maintained in DRT patients; and transient ischemic attack(TIA) occurred in 2 cases. Conclusion The incidence of DRT after LAAC with cryoablation balloon is high in AF patients, once DRT is diagnosed, AF patients should intensify anticogulant treatment regimens.
