Dr. Chen Kewei (right) explained that “left atrial appendage closure” is a new type of cardiac catheterization, which can greatly reduce the probability of stroke in the future. Chen Bobo (left) is able to ride a bicycle and enjoy life following undergoing one-stop surgery for “atrial fibrillation electric burn” and “left atrial appendage closure”. (Photo/provided by the Affiliated Hospital of China Medical University)
70-year-old Uncle Chen likes outdoor sports and cycling. Six years ago, he felt his heart beating violently. He went to the Cardiology Clinic of the Affiliated Hospital of China Medical University, and was diagnosed with atrial fibrillation by Dr. Kewei Chen from the Cardiovascular Department of the Department of Internal Medicine. After being evaluated by the stroke risk index, Uncle Chen began to take anticoagulant drugs for a long time.
However, a car accident last year caused bleeding from a pelvic cavity fracture. Dr. Chen Kewei assessed the risk of Uncle Chen’s bleeding and stopped anticoagulant drugs if surgery is required, which will increase the stroke rate by 5-20 times. Chen Kewei Uncle accepted the advice of Dr. Chen Kewei and decided to accept the comprehensive and precise treatment of atrial fibrillation: that is, to complete the “atrial fibrillation electric burn” and “left atrial appendage closure surgery” in the same operation.
The Affiliated Hospital of China Medical University uses preoperative computerized tomography 3D reconstruction technology combined with artificial intelligence surgical navigation system to assist in judging the surgical route and the most appropriate size of the left atrial appendage occluder device, making Uncle Chen’s surgery more accurate and perfect. Uncle Chen’s anticoagulant medication is simpler, and his heart function has returned to rhythm. Uncle Chen no longer needs to take high doses of anticoagulants. After his heart function improves, his endurance for cycling is also better, and he is not worried regarding serious bleeding caused by accidental injuries. .
According to domestic research, there are more than 250,000 people in Taiwan with atrial fibrillation, and the prevalence rate is regarding 1%. A proportion of young and middle-aged patients suffer from atrial fibrillation. In addition, people with a history of stroke, heart failure, high blood pressure or left atrial hypertrophy are more prone to atrial fibrillation.
Dr. Chen Kewei pointed out that the most common type of embolic stroke in Taiwan is arrhythmia called atrial fibrillation. Atrial fibrillation is abnormal electrical discharge activity in the atrium. Dizziness, weakness, dyspnea and other symptoms, some patients don’t even feel any symptoms at all.
Dr. Chen Kewei explained that once atrial fibrillation occurs, the atrium loses its systolic function, and the blood tends to stagnate in the atrium, gradually forming a coagulated blood clot (thrombus); when the blood clot leaves the heart with the blood flow to the brain or other organs, it will be blocked. Live vessels, resulting in ischemic infarction in the area, quite dangerous. Generally, following stroke risk assessment, most patients will need to take a sufficient dose of anticoagulant for life to eliminate potential blood clots and prevent embolic stroke.
Dr. Chen Kewei pointed out that high doses of anticoagulants may increase the risk of bleeding in patients with atrial fibrillation to varying degrees. There are also patients with cerebral vascular embolism, even though they are taking anticoagulant drugs, but still have a stroke.
Dr. Chen Kewei emphasized that a stroke caused by atrial fibrillation often affects the main motor and language areas of the brain, seriously impairing the patient’s ability to live. Dr. Chen Kewei further analyzed that regarding 90% of the blood clots caused by atrial fibrillation are formed in the left atrial appendage. Therefore, patients with atrial fibrillation should also perform “left atrial appendage closure surgery” as one of the methods to prevent stroke.
Dr. Chen Kewei said that “left atrial appendage closure” is a new type of cardiac catheterization. In a short time, a specially designed occluder can be sent into the left atrium through the micro-trauma of the thigh vein, and 90% of patients with atrial fibrillation can be cured. The left atrial appendage, the source of the blood clot, is completely sealed, which greatly reduces the risk of stroke in the future. When performing left atrial appendage closure, because the surgical approach is the same as for atrial fibrillation, we can perform both procedures simultaneously in appropriate patients.
The Affiliated Hospital of China Medical University has performed 180 cases of “left atrial appendage closure surgery”, all of which have been successfully completed. When performing comprehensive treatment, the impact of tissue edema following electrocautery on the size assessment of the left atrial appendage must be considered. The Affiliated Hospital of China Medical University is currently Using preoperative computerized tomography 3D reconstruction technology combined with artificial intelligence surgical navigation system to determine the surgical route and the most appropriate size of the left atrial appendage occluder device, it is not affected by factors such as electric cauterization during operation, and it is also better than traditional esophageal ultrasound or even Contrast agent left atrial appendage contrast is more accurate, and the results of this study will also be published at this year’s annual meeting of the International Heart Rhythm Society.
For patients with frequent episodes of atrial fibrillation, or patients with ineffective drug therapy or severe side effects, atrial catheter electrocautery can be used as a reference option for fundamental treatment. Eliminates abnormal electrical activity within the atria.
Dr. Lin Yannian, Department of Cardiology, Affiliated Hospital of China Medical University, who is in charge of “Atrial Fibrillation Electric Fever”, said that “Atrial Fibrillation Electric Fever” has been confirmed in international clinical research, which can effectively reduce the incidence of atrial fibrillation and improve the symptoms of atrial fibrillation. And help patients with heart failure to improve heart function (patients use drugs to control atrial fibrillation, the recurrence rate is 70% following one year; patients use atrial fibrillation electric fever, the recurrence rate is 30% following one year), compared with arrhythmia drug treatment, electric The effect of burning on the control of atrial fibrillation can reach more than 2 times.
The treatment of “atrial fibrillation electric burn” is the same as “left atrial appendage closure surgery”, and the electric burn part only takes regarding 20~30 minutes extra, so that patients can obtain comprehensive treatment for atrial fibrillation stroke prevention and rhythm control , will not cause additional burden to the patient.
Dr. Chen Kewei suggested that if patients often have heart palpitations, cannot measure the heartbeat correctly with a sphygmomanometer, or are known to have arrhythmia, they should first go to the cardiology clinic for examination as soon as possible. If the possibility of atrial fibrillation is found, further examinations such as heart rate monitoring and esophageal ultrasound should be performed according to the doctor’s advice. And discuss with the doctor such as long-term use of anticoagulant drugs, and “left atrial appendage closure surgery” plus atrial fibrillation electrocautery and other options to find the most suitable treatment for your lifestyle.
