心房顫動中風預防的新策略：經皮左心耳封堵手術

New Strategy for Stroke Prevention in Atrial Fibrillation

心房顫動為最常見的心律不整。目前文獻指出，心房顫動患者缺血性中風風險較一般人高3至5倍。其中造成腦血管阻塞的血塊來源，有90％來自於左心耳。左心耳發育自胚胎時期的第4周，是原始心房的一部分，具特殊的囊狀以及小梁狀的構造，使得血液容易在此淤積形成血塊。除了目前抗凝血藥物治療外，利用左心耳封堵手術，減少血塊產生的機率，是目前歐洲與美國心房顫動治療指引中建議之替代療法。左心耳封堵手術適合於無法長期使用抗凝血藥物的患者，包含因使用藥物造成嚴重出血後遺症、無法耐受抗凝血藥物以及使用藥物後仍反覆中風的高風險族群。本篇文章將著重討論不同的經皮左心耳封堵器、近來大型臨床試驗的最新結果以及臨床運用的情境。

Atrial fibrillation (AF) is the most common arrhythmia, complicated with increased risk of stroke. Ninety percent of thrombus comes from left atrial appendage, derived from the left wall of the primary atrium, which forms during the fourth week of embryonic development. The pathogenesis of thrombosis in AF may result from the blood stasis which occurs in the appendage owing to its shape and the trabeculations within it. Left atrial appendage occlusion (LAAO) is widely considered to be a nonpharmacologic strategy for reducing stroke risk, as well as an alternative to anticoagulation in patients with AF deemed unsuitable for long-term anticoagulation yet appropriate for short-term anticoagulation. European and American guidelines have both been updated and recommend considering LAAO in patients who have long-term contraindications to anticoagulation. This article highlights significant updates in studies and device technology as they pertain to LAAO.