Cover your “ears” to prevent stroke

Atrial fibrillation (atrial fibrillation) is a complex arrhythmia. The patient’s blood flow is not smooth, and it is easy to stagnate and form thrombus in the atrium. The thrombus will flow with the blood to various parts of the body. If it enters the brain, it will cause a stroke. Pathological studies have shown that 90% of the thrombus that causes stroke in patients with atrial fibrillation is formed in a recess in the heart called the left atrial appendage. Therefore, if the left atrial appendage is “covered”, the “base” for thrombosis in patients with atrial fibrillation can be “destroyed”, thereby reducing the risk of stroke. This is a revolutionary technology that has emerged in recent years-left atrial appendage occlusion.

The main complication of atrial fibrillation is thromboembolism. Stroke (stroke) is the most common and most harmful. The risk of stroke in patients with non-valvular atrial fibrillation is 5 times that of ordinary people. Because when atrial fibrillation occurs, the regular contractile activity of the atrium disappears, blood is easily stagnated, and thrombus will form. After the thrombus falls off, it will flow with the blood to the peripheral organs. If it enters the brain, it will cause a stroke.

In the past, there were two options for clinical treatment of atrial fibrillation: drug anticoagulation and radiofrequency ablation. In the past, drug prevention of stroke has mostly relied on oral warfarin, but it is necessary to monitor the INR (a coagulation index) regularly to prevent the risk of bleeding. The new anticoagulants that have emerged in recent years, such as rivaroxaban and dabigatran etexilate, do not require regular INR monitoring, which greatly reduces the difficulty of taking them, but they are expensive and difficult to deal with once bleeding. Elderly patients often have a variety of diseases, such as renal insufficiency, gastrointestinal bleeding, cardiovascular disease, memory loss, etc., long-term adherence to medication, regular follow-up, or contraindications to medication, so the anticoagulation rate is low. Become a high incidence of atrial fibrillation stroke in our country. Although radiofrequency ablation has been widely accepted, the success rate of treatment for chronic and permanent atrial fibrillation is still less than 50%. Some patients require repeated radiofrequency ablation, and some still require anticoagulation therapy after surgery.

With the deepening of clinical research, it was discovered that the left atrial appendage located on the left anterior and outer left side of the left atrium has a long and narrow structure, rich pectinate muscles and trabeculae, and numerous lacunar crypts, so it is easy to produce blood vortex and form thrombus. Clinically, 90% to 100% of thrombus in non-valvular atrial fibrillation occurs in the left atrial appendage. It can be seen that the left atrial appendage is the main place for thrombosis in atrial fibrillation, and strokes can be reduced and prevented if the left atrial appendage can be closed. Based on this hypothesis, left atrial appendage occlusion came into being, and it was officially launched in my country in 2014.

Left atrial appendage occlusion is a minimally invasive method, puncture into the left atrium, use a specific occluder to seal the opening of the left atrial appendage, block the traffic between the left atrium and the left atrial appendage, and “annihilate” the “base” of thrombus formation. The purpose of preventing thrombosis. The general operation time is about 60 minutes, and you can get out of bed 12 hours after the operation, and you can be discharged after one day of observation; the success rate of the operation is about 98%, and the perioperative complications are reduced to 2% to 3%; Short-term anticoagulation therapy does not require long-term medication, which not only reduces the risk of stroke, but also avoids serious bleeding complications that may be caused by anticoagulants. It not only brings health to patients, but also greatly reduces medical expenses.

The current guidelines recommend that there are contraindications (bleeding, allergies) to taking anticoagulant drugs, unwilling to take anticoagulant drugs for a long time, high bleeding risk, INR is not easy to reach the standard, fluctuating, stroke during taking anticoagulant drugs, atrial fibrillation combined with PCI Patients with renal insufficiency, low ablation success rate or multiple ablations, electrical isolation of the left atrial appendage, thrombosis or blood stasis found in the left atrial appendage, and strokes are all suitable for patients with left atrial appendage closure.