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

Tzikas, Apostolos; Gafoor, Sameer; Meerkin, David; Freixa, Xavier; Cruz-Gonzalez, Ignacio; Lewalter, Thorsten; Saw, Jacqueline; Berti, Sergio; Nielsen-Kudsk, Jens Erik; Ibrahim, Reda; Lakkireddy, Dhanunjaya; Paul, Vincent; Arzamendi, Dabit; Nietlispach, Fabian; Worthley, Stephen G; Hildick-Smith, David; Thambo, Jean Benoit; Tondo, Claudio; Aminian, Adel; Kalarus, Zbigniew; ... (2016). Left atrial appendage occlusion with the AMPLATZER Amulet device: an expert consensus step-by-step approach. EuroIntervention, 11(13), pp. 1512-1521. Europa Digital & Publishing 10.4244/EIJV11I13A292

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AIMS This document aims to describe a standardised methodology for performing left atrial appendage occlusion (LAAO) using the AMPLATZER Amulet device, and to provide useful tips and tricks for operators with different levels of experience. METHODS AND RESULTS Physicians who are experts in LAAO and had personal clinical experience with the AMPLATZER Amulet device were asked to contribute in the preparation of this consensus document. Twenty-seven physicians (20 interventional cardiologists and 7 electrophysiologists) from 14 different countries reviewed the manuscript. A step-by-step approach, simulating a real case, was followed. Starting with patient selection and planning, related cardiac imaging is discussed, followed by vascular access - transseptal puncture optimisation. Then, angiographic calibration/sizing and the required fluoroscopy views are explained and a device sizing strategy is proposed. Device preparation and de-airing is briefly described, followed by sheath exchange, device deployment steps, evaluation of device stability and decision for final release. The way to recapture and change a device is then shown, together with some additional tips on how to deal with challenging anatomies like "chicken wing" left atrial appendage. Finally, for operators who are switching from AMPLATZER Cardiac Plug to Amulet, the main differences between the two devices with respect to implantation technique are presented. CONCLUSIONS 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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Meier, Bernhard

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1774-024X

Publisher:

Europa Digital & Publishing

Language:

English

Submitter:

Daria Vogelsang

Date Deposited:

15 Mar 2017 12:05

Last Modified:

15 Mar 2017 12:05

Publisher DOI:

10.4244/EIJV11I13A292

PubMed ID:

27107315

URI:

https://boris.unibe.ch/id/eprint/92572

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