TY - JOUR

T1 - Left atrial appendage occlusion with the AMPLATZER Amulet device

T2 - an expert consensus step-by-step approach

AU - Tzikas, Apostolos

AU - Gafoor, Sameer

AU - Meerkin, David

AU - Freixa, Xavier

AU - Cruz-Gonzalez, Ignacio

AU - Lewalter, Thorsten

AU - Saw, Jacqueline

AU - Berti, Sergio

AU - Nielsen-Kudsk, Jens Erik

AU - Ibrahim, Reda

AU - Lakkireddy, Dhanunjaya

AU - Paul, Vincent

AU - Arzamendi, Dabit

AU - Nietlispach, Fabian

AU - Worthley, Stephen G

AU - Hildick-Smith, David

AU - Thambo, Jean Benoit

AU - Tondo, Claudio

AU - Aminian, Adel

AU - Kalarus, Zbigniew

AU - Schmidt, Boris

AU - Sondergaard, Lars

AU - Kefer, Joelle

AU - Meier, Bernhard

AU - Park, Jai-Wun

AU - Sievert, Horst

AU - Omran, Heyder

PY - 2016

Y1 - 2016

N2 - 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.

AB - 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.

KW - Atrial Appendage

KW - Atrial Fibrillation

KW - Cardiac Catheterization

KW - Consensus

KW - Echocardiography, Transesophageal

KW - Equipment Design

KW - Fluoroscopy

KW - Humans

KW - Punctures

KW - Septal Occluder Device

KW - Treatment Outcome

KW - Journal Article

U2 - 10.4244/EIJV11I13A292

DO - 10.4244/EIJV11I13A292

M3 - Journal article

C2 - 27107315

VL - 11

SP - 1512

EP - 1521

JO - EuroIntervention

JF - EuroIntervention

SN - 1774-024X

IS - 13

ER -