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


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.
AHEPA University Hospital, Thessaloniki, Greece.
Apostolos
A
Tzikas
Sameer
S
Gafoor
David
D
Meerkin
Xavier
X
Freixa
Ignacio
I
Cruz-Gonzalez
Thorsten
T
Lewalter
Jacqueline
J
Saw
Sergio
S
Berti
Jens Erik
JE
Nielsen-Kudsk
Reda
R
Ibrahim
Dhanunjaya
D
Lakkireddy
Vincent
V
Paul
Dabit
D
Arzamendi
Fabian
F
Nietlispach
Stephen G
SG
Worthley
David
D
Hildick-Smith
Jean Benoit
JB
Thambo
Claudio
C
Tondo
Adel
A
Aminian
Zbigniew
Z
Kalarus
Boris
B
Schmidt
Lars
L
Sondergaard
Joelle
J
Kefer
Bernhard
B
Meier
Jai-Wun
JW
Park
Horst
H
Sievert
Heyder
H
Omran
D020517:Atrial Appendage / Q000503:physiopathology / Q000601:surgery*; D001281:Atrial Fibrillation / Q000601:surgery*; D006328:Cardiac Catheterization / Q000295:instrumentation*; D032921:Consensus; D017548:Echocardiography, Transesophageal; D004867:Equipment Design; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D011677:Punctures; D055989:Septal Occluder Device; D016896:Treatment Outcome; D003245:Consensus Statements as Topic