Decyzje terapeutyczne w nadciśnieniu tętniczym — czy inhibitory konwertazy angiotensyny powinny być preferowane?

Abstract

Ischaemic stroke is a common complication of atrial fibrillation (AF). Cardiology societies recommend assessing the risk of ischaemic stroke and using adequate prevention in patients with AF. Currently, oral anticoagulants and antiplatelet drugs are the most commonly used methods of stroke prevention. Left atrial appendage (LAA) is thought to be the main source of thrombi in patients with AF. LAA closure procedures that have been recently introduced into the clinical practice are an alternative method of stroke prevention in patients with contraindications to oral anticoagulants or with a high risk of bleeding. Two systems of percutaneous LAA closure are currently available, the Watchman plug and the Amplatzer Cardiac Plug, but experience with these procedures is still very limited. To provide early results regarding safety and feasibility of percutaneous LAA closure with the Amplatzer Cardiac Plug in patients with AF and multiple comorbidities resulting in a high risk of stroke and bleeding complications. Twenty one patients with AF, at least 2 points in the CHADS2/CHA2DS2VASc score and a high risk of bleeding as assessed by the HAS-BLED score (at least 3 points) underwent percutaneous Amplatzer Cardiac Plug implantation. Patients with less than 3 points in the HAS-BLED score were also included in the study if they had contraindications to oral anticoagulants (e.g. previous haemorrhage, recurrent bleeding, epidermolysis) or suffered from recurrent ischaemic stroke despite anticoagulant treatment. The Amplatzer Cardiac Plug was implanted using the standard technique under fluoroscopic and echocardiographic guidance. Percutaneous LAA closure with the Amplatzer Cardiac Plug was performed in a group of patients with many comorbidities who had a high risk of ischaemic stroke (CHA2DS2VASc score 4.43 ± 1.4 points) as well as a high risk of bleeding (HAS-BLED score 3.0 ± 0.7 points). LAA occlusion was successfully performed in 20 (95.2%) patients. A serious periprocedural complication (cardiac tamponade requiring pericardiocentesis) occurred in 1 (4.76%) patient. Successful LAA occlusion is feasible in a vast majority of patients undergoing this procedure. The rate of serious periprocedural complications is relatively low. LAA occlusion is justified in a group of patients with a high risk of ischaemic stroke and a high risk of bleeding or contraindications to oral anticoagulants.