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

Apostolos Tzikas; Sameer Gafoor; David Meerkin; Xavier Freixa; Ignacio Cruz-Gonzalez; Thorsten Lewalter; Jacqueline Saw; Sergio Berti; Jens Erik Nielsen-Kudsk; Reda 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 Sondergaard; Joelle Kefer; Bernhard Meier; Jai-Wun Park; Horst Sievert; Heyder Omran

doi:10.4244/EIJV11I13A292

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

Apostolos Tzikas, Sameer Gafoor, David Meerkin, Xavier Freixa, Ignacio Cruz-Gonzalez, Thorsten Lewalter, Jacqueline Saw, Sergio Berti, Jens Erik Nielsen-Kudsk, Reda Ibrahim, Dhanunjaya Lakkireddy, Vincent Paul, Dabit Arzamendi, Fabian Nietlispach, Stephen G Worthley, David Hildick-Smith, Jean Benoit Thambo, Claudio Tondo, Adel Aminian, Zbigniew KalarusBoris Schmidt, Lars Sondergaard, Joelle Kefer, Bernhard Meier, Jai-Wun Park, Horst Sievert, Heyder Omran

Department of Clinical Medicine

54 Citations (Scopus)

Abstract

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.

Original language	English
Journal	EuroIntervention
Volume	11
Issue number	13
Pages (from-to)	1512-1521
Number of pages	10
ISSN	1774-024X
DOIs	https://doi.org/10.4244/EIJV11I13A292
Publication status	Published - Apr 2016

Keywords

Atrial Appendage
Atrial Fibrillation
Cardiac Catheterization
Consensus
Echocardiography, Transesophageal
Equipment Design
Fluoroscopy
Humans
Punctures
Septal Occluder Device
Treatment Outcome
Journal Article

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Tzikas, A., Gafoor, S., Meerkin, D., Freixa, X., Cruz-Gonzalez, I., Lewalter, T., Saw, J., Berti, S., Nielsen-Kudsk, J. E., Ibrahim, R., Lakkireddy, D., Paul, V., Arzamendi, D., Nietlispach, F., Worthley, S. G., Hildick-Smith, D., Thambo, J. B., Tondo, C., Aminian, A., ... Omran, H. (2016). Left atrial appendage occlusion with the AMPLATZER Amulet device: an expert consensus step-by-step approach. EuroIntervention, 11(13), 1512-1521. https://doi.org/10.4244/EIJV11I13A292

Tzikas, A, Gafoor, S, Meerkin, D, Freixa, X, Cruz-Gonzalez, I, Lewalter, T, Saw, J, Berti, S, Nielsen-Kudsk, JE, Ibrahim, R, Lakkireddy, D, Paul, V, Arzamendi, D, Nietlispach, F, Worthley, SG, Hildick-Smith, D, Thambo, JB, Tondo, C, Aminian, A, Kalarus, Z, Schmidt, B, Sondergaard, L, Kefer, J, Meier, B, Park, J-W, Sievert, H & Omran, H 2016, 'Left atrial appendage occlusion with the AMPLATZER Amulet device: an expert consensus step-by-step approach', EuroIntervention, vol. 11, no. 13, pp. 1512-1521. https://doi.org/10.4244/EIJV11I13A292

@article{b0d2a5a23c3545fe8a3da359c1bb5a51,

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

abstract = "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.",

keywords = "Atrial Appendage, Atrial Fibrillation, Cardiac Catheterization, Consensus, Echocardiography, Transesophageal, Equipment Design, Fluoroscopy, Humans, Punctures, Septal Occluder Device, Treatment Outcome, Journal Article",

author = "Apostolos Tzikas and Sameer Gafoor and David Meerkin and Xavier Freixa and Ignacio Cruz-Gonzalez and Thorsten Lewalter and Jacqueline Saw and Sergio Berti and Nielsen-Kudsk, {Jens Erik} and Reda Ibrahim and Dhanunjaya Lakkireddy and Vincent Paul and Dabit Arzamendi and Fabian Nietlispach and Worthley, {Stephen G} and David Hildick-Smith and Thambo, {Jean Benoit} and Claudio Tondo and Adel Aminian and Zbigniew Kalarus and Boris Schmidt and Lars Sondergaard and Joelle Kefer and Bernhard Meier and Jai-Wun Park and Horst Sievert and Heyder Omran",

year = "2016",

month = apr,

doi = "10.4244/EIJV11I13A292",

language = "English",

volume = "11",

pages = "1512--1521",

journal = "EuroIntervention",

issn = "1774-024X",

publisher = "Europa Digital & Publishing",

number = "13",

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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

Y1 - 2016/4

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

SN - 1774-024X

VL - 11

SP - 1512

EP - 1521

JO - EuroIntervention

JF - EuroIntervention

IS - 13

ER -

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

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Keywords

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