left atrial appendage (LAA) occlusion has emerged as an exciting and effective
modality for stroke prophylaxis in patients with non-valvular atrial
fibrillation who are deemed too high risk for anticoagulation with warfarin or
newer anticoagulants. The Amplatzer devices have been used in LAA occlusion for
more than a decade, starting with off label use of an atrial septal occluder
device for LAA occlusion. This was followed by introduction of a dedicated
Amplatzer cardiac plug (ACP) 1 for LAA occlusion, and more recently, the second
generation Amulet device, with reported better stability enhancing features, has
been introduced. Both these devices are widely used outside the United States,
where only the WATCHMAN device has been commonly used. Unlike the WATCHMAN
device, where the evidence is continuously building as the data from two
pivotal randomized controlled trials are emerging, most of the evidence for ACP
devices is from pooled multicenter registry data.
article, we review the device design, implantation techniques and the most
recently published evidence for both the Amplatzer cardiac plug 1 and the newer
Amulet device. Our goal is to summarize the most recent literature and discuss
the current role of the Amplatzer devices in the exciting and rapidly growing
field of percutaneous LAA occlusion.
Credits: Akhil Parashar MD; E. Murat Tuzcu MD FACC FSCAI; Samir R Kapadia MD FACC FSCAI.