杨德彦,高鹏,刘永太,陈太波,程中伟,邓华,程康安,林雪,陈未,方理刚,方全

• 1:中国医学科学院北京协和医学院北京协和医院心内科

摘要(Abstract)：

目的探讨非瓣膜性心房颤动(房颤)或心房扑动(房扑)患者左心房血栓(LAT)的危险因素以及抗凝治疗效果。方法回顾性分析2015年1月1日至2017年12月31日在北京协和医院拟行导管消融的非瓣膜性房颤或房扑患者333例,根据经食管超声心动图(TEE)结果分为LAT组和非LAT组;LAT组患者接受抗凝后,根据LAT溶解情况分为LAT溶解组和LAT持续组;比较患者临床资料和超声心动图指标,采用logistic单因素和多因素回归分析LAT危险因素和LAT持续存在危险因素。结果333例患者中22例(6.6%)存在LAT,logistic多因素回归分析提示左心室射血分数(LVEF)下降(<55%)是LAT独立危险因素(OR 6.112,95%CI 2.041～18.302,P=0.001);17例(17/22)LAT患者在抗凝中位时间98 d后接受复查,LAT溶解和持续分别为10例(10/17)和7例(7/17),logistic单因素回归分析左心房前后径≥46 mm是LAT持续的危险因素,但logistic多因素分析差异无统计学意义(OR17.633,95%CI 0.747～416.436,P=0.075)。结论非瓣膜性房颤和房扑患者中LAT常见,LVEF下降是LAT的独立危险因素,抗凝治疗后41.2%的LAT持续存在。

关键词(KeyWords)： 心房颤动;心房扑动;左心房血栓;导管消融

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 杨德彦,高鹏,刘永太,陈太波,程中伟,邓华,程康安,林雪,陈未,方理刚,方全

参考文献(References)：

• [1] Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace, 2018, 20(1):e1-e160.
• [2]胡宇才,白融,许丰强,等.全三维技术在老年心房颤动射频消融术中的安全性及有效性研究.中国介入心脏病学杂志,2017,25(11):622-627.
• [3] Wu M, Gabriels J, Khan M, et al. Left atrial thrombus and dense spontaneous echocardiographic contrast in patients on continuous direct oral anticoagulant therapy undergoing catheter ablation of atrial fibrillation:Comparison of dabigatran, rivaroxaban, and apixaban. Heart Rhythm,2018, 15(4):496-502.
• [4] Niku AD, Shiota T, Siegel RJ, et al. Prevalence and resolution of left atrial thrombus in patients with nonvalvular atrial fibrillation and flutter with oral anticoagulation. Am J Cardiol, 2019,123(1):63-68.
• [5] Lip GY, Hammerstingl C, Marin F, et al. Left atrial thrombus resolution in atrial fibrillation or flutter:Results of a prospective study with rivaroxaban(X-TRA)and a retrospective observational registry providing baseline data(CLOT-AF). Am Heart J, 2016,178:126-134.
• [6] Wu MS, Gabriels J, Khan M, et al. Left atrial thrombus despite continuous direct oral anticoagulant or warfarin therapy in patients with atrial fibrillation:insights into rates and timing of thrombus resolution. J Interv Card Electrophysiol, 2018, 53(2):159-167.
• [7] Huang J, Liao HT, Fei HW, et al. Association of thromboembolic risk score with left atrial thrombus and spontaneous echocardiographic contrast in non-anticoagulated nonvalvular atrial fibrillation patients. Cardiology, 2018, 140(2):87-95.
• [8] Decker JM, Madder RD, Hickman L, et al. CHADS(2)score is predictive of left atrial thrombus on precardioversion transesophageal echocardiography in atrial fibrillation. Am J Cardiovasc Dis,2011,1(2):159-165.
• [9] Bertaglia E, Anselmino M, Zorzi A, et al. NOACs and atrial fibrillation:Incidence and predictors of left atrial thrombus in the real world. Int J Cardiol, 2017, 249:179-183.