專題討論13:心房顫動病人何時適合左心房封堵術?

程 序 表

S13-4
左心封堵術:技術面
羅力瑋
臺北榮總醫院內科部心臟內科

  Atrial fibrillation is a common cardiac arrhythmia, especially among elders. It will increase the risk of stroke to 5 times than the general population. Pharmacological stroke prevention is the mainstay currently applied worldwide. Unfortunately, some patients still suffered from repeated embolic events after adequate anticoagulation or intolerable to oral anticoagulant due to bleeding side effect. Therefore, left atrial appendage (LAA) closure is an alternative to solve this issue.
  The LAA is a small, ear-shape sac in the muscle wall of the leaf atrium (top left chamber of the heart). In normal heart, the blood in the left atrium and LAA is squeezed out of the left atrium to the left ventricle. However, in atrial fibrillation, the fast and chaotic impulses do not give the atria time to contract and/or effectively squeeze blood into the ventricle. The stasis of the blood in the LAA can form clots. When those blood blots are pumped out of the heart, they can cause the stroke. The LAA is considered the main reservoir for the left atrial thrombi in >90% of the patients with nonvalvular atrial fibrillation.
  In recent years, the percutaneous LAA closure has rapidly grown worldwide as a promising alternative for the prevention of thromboembolisms in patients at high risk for stroke, with a specific focus on patients ineligible for oral anticoagulant. Currently, we have two transcatheter LAA closure devices in Taiwan (Watchman and Amulet). Watchman closure device had been approved by FDA and Amulet by CE. In this lecture, the procedural technique aspect will be reported for the implantation in both LAA closure devices.