左心耳封堵術在心房顫動患者之應用

Left Atrial Appendage Closure for Atrial Fibrillation

竇巧雲(Chiao-Yun Tou) ； 李秀卿(Hsiu-Ching Li) ； 蔡佳醍(Chia-Ti Tasi) ； 黃珊惠(Shan-Hui Huang) ； 陳佳慧(Chia-Hui Chen) ； 孫佩勤(Pei-Chin Sun)

《台灣醫學》 20卷1期 (2016/01) Pp. 85-90

https://doi.org/10.6320/FJM.2016.20(1).11

摘要

心房顫動是臨床上最常見的心律不整，容易產生動脈血栓，是引起缺血性腦中風主要的原因。Warfarin的治療是目前缺血性腦中風的主要選項，部分心房顫動的病患有高危出血的傾向，不適合抗凝血劑藥物治療，新一代的口服抗凝血劑對腎功能不良者並不適用，此時左心耳封堵術(left atrial appendage closure)的研發可作為替代治療。隨經驗累積、技術進步與左心耳封堵器的改良，左心耳封堵術臨床應用成功率已大幅提升。本文將分別說明心房顫動的流行病學、診斷及治療目標。並介紹左心耳封堵術的發展及臨床照顧重點，期望提升臨床醫護人員對心房顫動及左心耳封堵術的認識，進而強化臨床心房顫動照護品質，達到腦中風防治之具體成效。

關鍵字

心房顫動 ； 左心耳封堵術 ； 缺血性中風

並列摘要

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia encountered in clinical practice. One of its most devastating complications is the development of thromboembolism leading to ischemic stroke. Oral anticoagulation is the standard treatment for stroke prevention but patients with high risk of bleeding or who are intolerant for the medication are contraindicative. As an alternative, percutaneous left atrial appendage (LAA) closure is an evolving therapy. This article aims to review the definition and epidemiology of AF, and treatment of AF including the rationale and care for LAA closure. We hope by increasing the awareness among professionals, early referral and person-tailored intervention could be initiated to improve care and prevention of stroke in the growing number of patients with AF.

並列關鍵字

atrial fibrillation ； left atrial appendage ； ischemic stroke

參考文獻

林盈利、陳清埤、余昭宏等：心房顫動與抗血栓治療。家庭醫學與基層醫療 2012;27:202-6。[Lin Y, Chen C, Yu C, et al: Atrial fibrillation and antithrombotic therapy. Family Medicine & Primary Medical Care 2012;27:202-6.]

Pinho-Gomes AC, Amorim MJ, Oliveira SM, et al: Surgical treatment of atrial fibrillation: an updated review. Eur J Cardiothorac Surg 2014: 46:167-78.

Yu HC, Tsai YF, Chen MC, et al: Underuse of antithrombotic therapy caused high incidence of ischemic stroke in patients with atrial fibrillation. Int J Stroke 2012;7:112-7.

Camm AJ, Kirchhof P, Lip GY, et al: Guidelines for the management of atrial fibrillation: the task force for the management of atrial fibrillation of the European Society of Cardiology. Eur Heart J 2010;19: 2369-429.

Heeringa J, van der Kuip DA, Hofman A, et al: Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J 2006;27:949-53.