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 - 2016/4/20
Y1 - 2016/4/20
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 - Journal Article
U2 - 10.4244/EIJV11I13A292
DO - 10.4244/EIJV11I13A292
M3 - Journal article
C2 - 27107315
SN - 1774-024X
VL - 11
SP - 1512
EP - 1521
JO - EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
JF - EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
IS - 13
ER -