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

2016; European Association of Percutaneous Cardiovascular Interventions; Volume: 11; Issue: 13 Linguagem: Inglês

10.4244/eijv11i13a292

1969-6213

Apostolos Tzikas, Sameer Gafoor, David Meerkin, Xavier Freixa, Ignacio Cruz‐González, Thorsten Lewalter, Jacqueline Saw, Sérgio Berti, Jens Erik Nielsen‐Kudsk, Réda Ibrahim, Dhanunjaya Lakkireddy, Vincent Paul, Dabit Arzamendi, Fabian Nietlispach, Stephen G. Worthley, David Hildick‐Smith, Jean Benoit Thambo, Claudio Tondo, Adel Aminian, Zbigniew Kalarus, Boris Schmidt, Lars Søndergaard, Joëlle Kefer, Bernhard Meier, Jai‐Wun Park, Horst Sievert, Heyder Omran,

Cardiac pacing and defibrillation studies

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.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.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.