Amplatzer amulet versus watchman device for percutaneous left atrial appendage closure: A systematic review and meta-analysis

Abstract

Background: The Amplatzer Amulet (AA) and Watchman devices (WD) are the 2 most frequently used devices for percutaneous LAA closure globally. Objective: To evaluate the safety and clinical outcomes associated with these 2 devices in patients undergoing percutaneous LAA closure. Method: We systematically searched all electronic databases from inception until February 21, 2023. The primary endpoint was procedure related complications. Secondary endpoints were device related thrombus, stroke, cardiovascular mortality, peri device leak, systemic embolism, and all-cause mortality. Results: A total of 3 randomized clinical trials with 2150 patients were included in this meta-analysis. The mean age was 75 and 76 years in the Amplatzer group and in the Watchman group, respectively. The odds of procedure-related complications (OR, 1.80 [95% CI: 1.21–2.67], P < .001) were significantly higher among patients with AA compared to the WD. However, the odds of all-cause mortality (OR, 0.75 (95% CI: 0.49–1.16), P = .20), stroke (OR, 0.79 [95% CI: 0.47–1.34], P = .39), systemic/pulmonary embolism (OR, 1.34 [95% CI: 0.30–6.04], P = .70), and major bleeding (OR, 1.10 [95% CI: 0.83–1.48], P = .50) were comparable between the two devices. The odds of device related thrombus (OR, 0.72 [95% CI: 0.46–1.14], P = .17) was comparable between both the group of patients, however the incidence of peri device leak was significantly lower in AA group (OR, 0.41 [95% CI: 0.26–0.66], P < .001) compared with WD group of patients. Conclusion: The AA was not superior to the Watchman device in terms of safety and efficacy. However, the Amulet occluder was associated with a higher incidence of procedure-related complications, and lower peri device leak.

Should the Left Atrial Appendage Closure (LAAC) Technique Be the Main Form of Stroke Prevention in Patients With Long-Standing Persistent or Permanent Atrial Fibrillation?

“…The procedure is used to occlude the left atrial appendage (LAA), the site of 90% of thrombus formation in Afib patients [7]. The two current commercially available LAAC devices in the United States (US) include the Boston Scientific WATCHMAN FLX LAAC device (Boston Scientific, Marlborough, USA), and the Abbott Amplatzer Amulet LAA occluder device (Abbott, Chicago, USA) [8]. Currently, OAC is considered the gold standard for stroke prevention in Afib patients [9].…”

Comprehensive cardiosurgical intervention for displaced Amplatzer Amulet device with atrial fibrillation complications

“…According to the medical literature, primary indications include the reduction of stroke risk in atrial fibrillation patients, especially those with additional risk factors such as prior strokes or a predisposition to bleeding. Occluders are also contemplated for patients with contraindications to prolonged anticoagulant therapy [ 5 ].…”