Minimally invasive thoracoscopic left atrial appendage occlusion compared with transcatheter left atrial appendage closure for stroke prevention in recurrent nonvalvular atrial fibrillation patients after radiofrequency ablation:a prospective cohort study

摘要

BACKGROUND Tanscatheter left atrial appendage(LAA)closure and minimally invasive thoracoscopic LAA occlusion are local interventions of LAA for stroke prevention in patients with nonvalvular atrial fibrillation(NVAF).However,the safety and efficacy of these methods have not been compared.This prospective cohort study aimed to assess the safety and efficacy of those two treatment approaches for stroke prevention in NVAF patients.METHODS Two hundred and nine recurrent NVAF patients who received radiofrequency ablation were enrolled.These pa-tients were treated with transcatheter LAA closure or thoracoscopic LAA occlusion.The patients were followed up from the first postoperative day and evaluated for efficacy endpoints(stroke/transient ischemic attack(TIA),systemic embolism(SE),and death)and a safety endpoint(bleeding events).Perioperative complications were recorded.RESULTS After a median follow-up of 1.8 years(383 patient-years),the overall rate of the composite efficacy endpoints was similar between the two groups(3.8 vs.2.7 events per 100 patient-years;HR=0.71;95%CI:0.225−2.237;P=0.559).However,regarding primary safety endpoint,there were 1.5 bleeding events per 100 patient-years in the thoracoscopic LAA occlusion group,com-pared with 6.4 in transcatheter LAA closure group(HR=0.246;95%CI:0.074−0.819;P=0.022).The incidence of operative com-plications was 3/138(2.17%)in thoracoscopic LAA occlusion group and 1/71(1.41%)in transcatheter LAA closure group.CONCLUSIONS Thoracoscopic LAA occlusion and transcatheter LAA closure have similar efficacy in preventing stroke in NVAF patients.However,the thoracoscopic group had fewer bleeding events than the transcatheter group,but the former group required a longer hospital stay.