Left atrial appendage occlusion with the AMPLATZER Amulet device: an expert consensus step-by-step approach

Abstract

In conclusion, this document reflects a consensus approach by expert implanters on the steps of LAAO technique and best practices for implantation of the AMPLATZER Amulet device, along with some practical tips to minimise the complication rate.

Left atrial appendage closure in patients with osler disease and atrial fibrillation

“…In our study, the primary endpoint was the safety and efficacy of percutaneous LAAc with the AMPLATZER Amulet device in the prevention of thromboembolic events in patients with AF and Osler disease at a mid-term (sixmonth) follow-up. The secondary endpoint was the effectiveness of post-procedural single antiplatelet therapy as a non-pharmacological In our three clinical cases, we found no thrombi on the device after 6 months' follow-up, which supports the observations by Tzikas et al [21] that the AMPLATZER Amulet device could eliminate the need for OAC therapy for the prevention of thrombus formation. All our three patients with Osler disease received either Aspirin or Clopidogrel.…”

“…The procedure for LAAc was performed as described by Earley and Tzikas et al [21,22]. under TEE guidance and anesthesia.…”

“…If thrombus was present in the LAA, OAC therapy was recommended for four weeks or until the thrombi dissolves. We also used the baseline TEE to detect pericardial effusion and to assess the function of mitral valve and patency of the left upper pulmonary vein [21]. We also checked for other contraindications for LAAc with AMPLATZER Amulet device such as presence of infective endocarditis, extreme LAA sizes, extensive congenital cardiac anomaly only treated by surgery, sepsis or untreated ulcer a month to implantation, bleeding disorder, untreated ulcer, contraindications for Aspirin or Clopidogrel, pregnancy and device interference with other inter-cardiac structures [15].…”

“…The device also has a proximal screw, which when recessed, minimizes formation of thrombus on the proximal disc and facilitate device re-attachment to the pusher screw. The device is suitable for LAA neck diameters 11-31 mm and depth ≥12 mm [21].…”

Barriers for a Wider Use of Left Atrial Appendage Occlusion as an Alternative to Oral Anticoagulation

“…In this case, the embolization rate seems to be slightly superior (2%). Careful procedures and some tips [8] can help in shortening the time span of the learning curves.…”