title: Left atrial appendage occlusion: initial experience with the Amplatzer™ Amulet™.
abstract: BACKGROUND
  The Amplatzer™ Amulet™ (Amulet) is the evolution of the Amplatzer™ Cardiac Plug, a dedicated device for percutaneous left atrial appendage (LAA) occlusion. The new device has been designed to facilitate the implantation process, improve the sealing performance and further reduce the risk of complications. The objective of the study was to describe the initial experience with the Amplatzer Amulet for percutaneous LAA occlusion.
  
  
  METHODS
  This was a prospective single-center study of patients undergoing percutaneous LAA occlusion. The indication for LAA closure was a formal contraindication for oral anticoagulation or previous history of stroke due to INR lability. All procedures were done under general anesthesia and transesophageal echocardiography (TEE) guidance. Transthoracic echocardiography was performed 24h after the procedure in order to rule out procedural complications before discharge. Further follow-up was done with a clinical visit and TEE at 1-3 months.
  
  
  RESULTS
  Between July-2012 and June-2013, 25 patients with a mean CHA2DS2-VASC of 4.3 ± 1.7 underwent LAA occlusion with the Amplatzer Amulet. The device was successfully implanted in 24 patients (96%) without any procedural stroke, pericardial effusion or device embolization. None of the patients presented any clinical event at follow-up. Follow-up TEE showed complete LAA sealing in all patients with no residual leaks >3mm and no device embolization. One patient (4.1%) presented a device thrombosis at follow-up without clinical expression.
  
  
  CONCLUSIONS
  In this initial series of patients, the Amulet showed a remarkable acute and short-term performance in terms of feasibility and safety as depicted by the high successful implantation rate and the low incidence of complications.
authors.affiliation: Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada; Department of Cardiology, Thorax Unit, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Freixa
authors.affiliation: Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Ali
authors.initials: A
authors.lastname: Abualsaud
authors.affiliation: Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Jason
authors.initials: J
authors.lastname: Chan
authors.affiliation: Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Nosair
authors.affiliation: Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada; Interbalkan European Medical Center, Thessaloniki, Greece.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Tzikas
authors.affiliation: Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Patrick
authors.initials: P
authors.lastname: Garceau
authors.affiliation: Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Arsène
authors.initials: A
authors.lastname: Basmadjian
authors.affiliation: Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada. Electronic address: reda.ibrahim@icm-mhi.org.
authors.forename: Réda
authors.initials: R
authors.lastname: Ibrahim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000601:surgery*; D006328:Cardiac Catheterization / Q000295:instrumentation* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation* / Q000379:methods; D011446:Prospective Studies; D011859:Radiography; D055989:Septal Occluder Device / Q000592:standards / Q000639:trends; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: Amplatzer cardiac plug; Amulet; Atrial fibrillation; Left atrial appendage; Stroke