Left atrial appendage occlusion with the Amplatzer Amulet: update on device sizing
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Left atrial appendage occlusion with the Amplatzer Amulet: update on device sizing Xavier Freixa 1 & Adel Aminian 2 & Apostolos Tzikas 3 & Jacqueline Saw 4 & Jens-Erick Nielsen-Kudsk 5 & Alexander Ghanem 6 & Boris Schmidt 7 & David Hildick-Smith 8 Received: 13 June 2019 / Accepted: 23 December 2019 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose The present paper analyzes the role of different imaging modalities for left atrial appendage (LAA) assessment and the recommended specific measurements to improve device selection with regard to the Amulet device. Background Morphological LAA assessment is one of the pivotal factors to achieve proper LAA sealing and potentially reduce the risk of complications by minimizing manipulation inside the appendage. Methods Eight experienced physicians in LAAO were asked to contribute in the preparation of a device sizing consensus manuscript after comprehensive assessment of previous published data on LAA imaging/measurement. Results LAA morphology is often complex and requires more detailed spatial resolution and 3-dimensional assessments to reduce the risk of mis-sizing. Traditionally, upsizing of devices based upon the largest measured LAA diameters have been used. However, this may lead to oversizing in markedly elliptical appendages. Thus, when 3D imaging modalities are available, utilizing the LAA mean diameters might be a better alternative. Operators should also note the systematic biases in differences in measurements obtained with different imaging modalities, with CT giving the largest measurements, followed by 3D-TEE, and then 2D-TEE and angiography. In fact, for 2D imaging techniques (2D-TEE and angiography), LAA diameters tend to be underestimated, and therefore, LAA largest diameters seem to be still the best option for device sizing. Some specific anatomies such as proximal chicken-wing or conic LAAs may require different measurements and implantations to achieve implant success. Conclusions In conclusion, LAA mean diameters might be a better alternative to largest diameters when 3D imaging modalities are available. Keywords Left atrial appendage . Amulet . Stroke . Sizing . Atrial fibrillation
1 Introduction
* Xavier Freixa [email protected] 1
Hospital Clinic de Barcelona, Institut Clínic Cardiovascular, Barcelona, Spain
2
Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
3
AHEPA University Hospital, Thessaloniki, Greece
4
Vancouver General Hospital, Vancouver, British Columbia, Canada
5
Aarhus University Hospital, Skejby, Denmark
6
Asklepios Klinik St. George, Hamburg, Germany
7
Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
8
Sussex Cardiac Center, Brighton, UK
Left atrial appendage (LAA) occlusion (LAAO) procedural volume has grown rapidly in several countries worldwide [1, 2]. It is a valid alternative to oral anticoagulation (OAC) with increasing evidence of efficacious long-term follow-up data. Similar to other novel interventional techniques, the progressiv
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