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Left atrial appendage occlusion with the Amplatzer Amulet: update on device sizing

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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.

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Authors and Affiliations

  1. Hospital Clinic de Barcelona, Institut Clínic Cardiovascular, Barcelona, Spain

    Xavier Freixa

  2. Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium

    Adel Aminian

  3. AHEPA University Hospital, Thessaloniki, Greece

    Apostolos Tzikas

  4. Vancouver General Hospital, Vancouver, British Columbia, Canada

    Jacqueline Saw

  5. Aarhus University Hospital, Skejby, Denmark

    Jens-Erick Nielsen-Kudsk

  6. Asklepios Klinik St. George, Hamburg, Germany

    Alexander Ghanem

  7. Cardioangiologisches Centrum Bethanien, Frankfurt, Germany

    Boris Schmidt

  8. Sussex Cardiac Center, Brighton, UK

    David Hildick-Smith

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  1. Xavier Freixa
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Corresponding author

Correspondence to Xavier Freixa.

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Conflict of interest

XF, AA, AT, JS, JN, AG, BS, and DH are proctors for Abbott Medical.

Ethical approval

Since this manuscript is an expert consensus based on personal experience and previous published data, no specific ethical committee approval nor patient/animal consent were necessary.

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Freixa, X., Aminian, A., Tzikas, A. et al. Left atrial appendage occlusion with the Amplatzer Amulet: update on device sizing. J Interv Card Electrophysiol 59, 71–78 (2020). https://doi.org/10.1007/s10840-019-00699-5

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  • DOI: https://doi.org/10.1007/s10840-019-00699-5

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