Professor Wang Jian'an: From the stroke prevention of atrial fibrillation patients, look at the future development of LAAC

In China's population aging process is accelerating today, the rising incidence of cardiovascular diseases to the community and families have brought a heavy burden, atrial fibrillation as the most common arrhyth arrhythmic in the clinic, greatly increased the risk of stroke patients, and left ear blocking (LAAC) as an effective way to prevent and control atrial fibrillation, for the majority of atrial fibrillation patients provide a new choice.
recently, "Outpatient" invited Professor Wang Jian'an, Party Secretary of the Second Hospital affiliated with Zhejiang University Medical College, to discuss the future development direction of LAAC in the light of the current situation of LAAC development in China.
prevention in patients with atrial fibrillation is a hot topic of concern to clinicians in the field of atrial fibrillation. What solutions does LAAC bring to clinicians as an emerging technology? Professor Wang Jian'an: The incidence and prevalence of atrial fibrillation has remained high worldwide, and epidemiological studies show that the prevalence of atrial fibrillation is more than 10% among people over 75 years of age.
studies have shown that atrial fibrillation is closely related to age.
In the aging process is accelerating today, the number of atrial fibrillation patients in China is also rising sharply, arterial system embolism as the most important hazard of atrial fibrillation, but also caused ischemic stroke, causing great damage to the physical and mental health of our people, but also brought a heavy medical burden.
Health China Action (2019-2030), atrial fibrillation is an important cause of ischemic stroke, and it is recommended that patients with atrial fibrillation follow medical advice to use anticoagulant therapy.
In the anticoagulant treatment of atrial fibrillation patients, the traditional anticoagulant huafalin showed good clinical results, but huafalin has a certain risk of bleeding, and the need for long-term monitoring of INR, for patients to adhere to long-term anticoagulant inconvenience;
, at present, the compliance of anticoagulant treatment in atrial fibrillation patients in China is generally low, the quality of anticoagulant treatment is generally lower than that of patients in Europe and the United States, and more than half of patients have the phenomenon of insufficient anticoagulant.
results of the China Atrial Fibrillation Registration Study show that about 22% of patients with a CHA2DS2-VASc score of ≥2, i.e. those requiring anticoagulant drugs, did not receive anticoagulant therapy.
the irregularity of anticoagulant therapy and the lower therapeutic compliance of patients, which bring great challenges to the prevention of stroke in patients with atrial fibrillation.
the emergence of left-heart ear sealing (LAAC) has broken this deadlock, as a new technology to prevent stroke events in patients with non-valve atrial fibrillation (NVAF), the safety and effectiveness of left-heart ear blocking has been clinically recognized.
five-year follow-up results from the PROTECT-AF study and the PREVAIL study showed that LAAC had some advantages in preventing stroke in NVAF patients compared to Huafalin.
PRAGUE-17 study showed that LAAC was not inferior to NOAC in preventing cardiovascular events in patients with high risk of stroke.
the publication of the EWOLUTION registration study and the NCR registration study, it is further proved that LAAC can effectively reduce the stroke rate of NVAF patients and can effectively replace the long-term drug anticoagulant therapy.
Based on sufficient evidence-based evidence, relevant guidelines and expert consensus at home and abroad clearly recommend and recommend LAAC for stroke prevention in NVAF patients, bringing new hope to the vast number of patients with high stroke risk and long-term anticoagulant taboos.
With the accumulation of evidence-based evidence, more and more clinicians are aware of the clinical benefits LAAC brings to the vast majority of atrial fibrillation patients; What problems will coronary intervention physicians face when learning the technology? Professor Wang Jian'an: At present, the technique of left-heart ear blocking is mainly carried out by electrophysiologists, but LAAC, as an emerging technology that can effectively prevent ischemic stroke, should be understood by more physicians and applied to clinical work.
LAAC operation technology is relatively simple, with coronary intervention, atrial fibrillation, congenital heart disease intervention blocking treatment experience of clinicians can be relatively easy to master, and the success rate will be increasing with the accumulation of surgical experience.
It should be noted, however, that beginners still need to carry out systematic training to re-learn LAAC technology, and successfully carry out more than 10 cases of left-heart ear sealing, which can be used as an independent left-heart ear sealing method of the assessment basis.
For clinicians who currently focus on coronary intervention, the biggest challenge in the learning process is the recognition of interstitiograms, familiar with the relationship between the heart anatomy, the relationship between the left heart ear and the left upper lung vein, and the normal or mutated form of the left heart ear anatomy, if you can quickly grasp the relevant anatomical structure and surgery, will greatly improve the safety of surgery, better independent left heart ear blocking.
as for the esoesotic ultrasound physicians and anesthesiologists necessary for left heart ear sealing, regular surgical training and cooperation should be carried out by regular fixed personnel.
, the development of left-heart ear blocking will promote the common development of all departments in the hospital and improve the overall level of medical care in the hospital.
how to develop a reasonable drug treatment plan for patients with atrial fibrillation combined coronary heart disease has always been a difficult point in clinical work, how do you think the emergence of LAAC has changed the treatment strategies of such patients? What is the guiding significance of future clinical treatment? Professor Wang Jian'an: The results of the relevant epidemiological studies show that about 40% of patients with atrial fibrillation have coronary heart disease, and the prognosis of such patients is not optimistic, anticoagulant anticoagulant management for patients with atrial fibrillation combined coronary heart disease has always been a great challenge for the physician.
For patients with coronary heart disease with atrial fibrillation, antiplate plate plate therapy and anticoagulant therapy are irreplaceable, but the combination of anticoagulant drugs and antiplateboard drugs significantly increases the risk of bleeding in patients, there is currently no effective drug treatment program, in order to ensure the benefits of isoemia, without increasing the risk of bleeding.
LAAC has provided a new solution for the treatment of patients with atrial fibrillation combined coronary heart disease, and existing studies have confirmed that LAAC can be used as an alternative to anticoagulant therapy in patients with non-valve atrial fibrillation, effectively reducing the rate of ischemic stroke events while at once and for all addressing the risk of bleeding from anticoagulant therapy in patients with non-valve atrial fibrillation.
Second, a number of clinical studies and real-world results of EWOLUTION show that for patients with anticoagulant taboos, the use of DAPT after LAAC can effectively prevent device-related thrombosis (DRT) events, and for patients with atrial fibrillation with combined coronary heart disease, PCI joint LAAC does not increase the risk of surgery, LAAC postoperative double anti-treatment can significantly reduce bleeding events and does not increase the risk of stroke.
refore, in clinical work, coronary physicians should also pay attention to the treatment of atrial fibrillation, pay attention to the clinical benefits that LAAC brings to patients, and according to the actual situation of patients, the rational choice of LAAC or PCI joint LAAC technology.
Under the current national policy of purchasing the volume of coronary stents, the financial burden of patients has decreased significantly, and more advanced treatment options can be taken into account to provide a better prognosis for the treatment of coronary heart disease combined with atrial fibrillation patients.
in the rapid development of interventional therapy technology today, how do you see the future development trend of left-heart ear blocking technology in China? How to grasp the patient's adaptive disorder more reasonably? Professor Wang Jian'an: Due to the accelerating aging process, the number of atrial fibrillation patients in China will certainly be more and more, how to carry out effective screening and stroke prevention, will be the future of all the doctors of the major issues of deep concern.
LAAC, as an emerging technology that can effectively prevent stroke in patients with non-valve atrial fibrillation, deserves to be studied by all physicians and applied to the clinic.
It should be noted, however, that while widely used, patient adaptation should be strictly grasped, for patients who are unable to withstand side effects such as bleeding from anticoagulant therapy or long-term anticoagulant therapy, do not want to take anticoagulants or anticoagulant treatment with poor compliance, with a high risk of stroke, recommended left heart ear blocking treatment; Patients at risk of bleeding; patients with atrial fibrillation failure/multiple relapses and large left room; patients with hemodialysis/renal inseconcilation not suitable for NOAC; patients with anatomy of the heart and ear prone to blood retention/thrombosis; and patients with a history of stroke/intracranial bleeding) were also the best group of patients who benefited from left ear blockage.
In addition, if the clinical work found that patients in full anticoagulant and compliance is better, there are still ischemic events, it is recommended that LAAC to prevent the occurrence of heart-induced stroke events, for some young patients, taking into account the quality of life of patients and the potential risk of bleeding anticoagulant treatment, LAAC treatment can also be used to prevent stroke caused by atrial fibrillation.
In the future, with the further development of relevant clinical research, it may be possible to further expand the application of left heart ear blocking, so that left heart ear blocking become a different atrial fibrillation patients to prevent stroke personalized choice;
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