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

被引：78

作者：

Tzikas, Apostolos ^{[1
,2
]}

Gafoor, Sameer ^{[3
]}

Meerkin, David ^{[4
]}

Freixa, Xavier ^{[5
]}

Cruz-Gonzalez, Ignacio ^{[6
]}

Lewalter, Thorsten ^{[7
]}

Saw, Jacqueline ^{[8
]}

Berti, Sergio ^{[9
]}

Nielsen-Kudsk, Jens Erik ^{[10
]}

Ibrahim, Reda ^{[11
]}

Lakkireddy, Dhanunjaya ^{[12
]}

Paul, Vincent ^{[13
]}

Arzamendi, Dabit ^{[14
]}

Nietlispach, Fabian ^{[15
]}

Worthley, Stephen G. ^{[16
]}

Hildick-Smith, David ^{[17
]}

Thambo, Jean Benoit ^{[18
,19
]}

Tondo, Claudio ^{[20
]}

Aminian, Adel ^{[21
]}

Kalarus, Zbigniew ^{[22
]}

Schmidt, Boris ^{[23
]}

Sondergaard, Lars ^{[24
]}

Kefer, Joelle ^{[25
]}

Meier, Bernhard ^{[26
]}

Park, Jai-Wun ^{[27
]}

Sievert, Horst ^{[3
]}

Omran, Heyder ^{[28
]}

机构：

[1] AHEPA Univ Hosp, Kiriakidi 1, Thessaloniki 54621, Greece

[2] Interbalkan European Med Ctr, Thessaloniki, Greece

[3] CardioVasc Ctr Frankfurt, Frankfurt, Germany

[4] Shaare Zedek Med Ctr, Jerusalem, Israel

[5] Univ Barcelona, Hosp Clin, Barcelona, Spain

[6] Univ Hosp Salamanca, Salamanca, Spain

[7] Isar Heart Ctr Munich, Munich, Germany

[8] Univ British Columbia, Vancouver Gen Hosp, Vancouver, BC V5Z 1M9, Canada

[9] Fdn Toscana Gabriele Monasterio, Massa, Italy

[10] Aarhus Univ Hosp, Skejby, Denmark

[11] Montreal Heart Inst, Montreal, PQ H1T 1C8, Canada

[12] Univ Kansas Hosp, KU Cardiovasc Res Inst, Bloch Heart Rhythm Ctr, Kansas City, KS USA

[13] Fiona Stanley Hosp, Perth, WA, Australia

[14] Hosp Santa Creu & Sant Pau, Barcelona, Spain

[15] Univ Zurich Hosp, CH-8091 Zurich, Switzerland

[16] Univ Adelaide, Adelaide, SA, Australia

[17] Brighton & Sussex Univ Hosp, Sussex Cardiac Ctr, Brighton, E Sussex, England

[18] CHU Bordeaux, Hop Cardiol Haut Leveque, Bordeaux, France

[19] Univ Bordeaux, INSERM 1045, LIRYC LInst RYthmol & Modelisat Cardiaque, Bordeaux, France

[20] Univ Milan, IRCCS, Ctr Cardiol Monzino, Cardiac Arrhythmia Res Ctr, Milan, Italy

[21] Univ Charleroi, Ctr Hosp, Charleroi, Belgium

[22] Silesian Med Sch, Silesian Ctr Heart Dis, Zabrze, Poland

[23] Cardioangiol Ctr Bethanien, Frankfurt, Germany

[24] Rigshosp, DK-2100 Copenhagen, Denmark

[25] St Luc Univ Hosp, Brussels, Belgium

[26] Univ Hosp Bern, CH-3010 Bern, Switzerland

[27] Coburg Hosp, Coburg, Germany

[28] Univ Hosp Bonn, Bonn, Germany

来源：

EUROINTERVENTION | 2016年 / 11卷 / 13期

关键词：

LAA closure; prevention; stroke; technique; 3-DIMENSIONAL TRANSESOPHAGEAL ECHOCARDIOGRAPHY; CARDIAC PLUG DEVICE; INTRACARDIAC ECHOCARDIOGRAPHY; INITIAL-EXPERIENCE; STROKE PREVENTION; WARFARIN THERAPY; WATCHMAN DEVICE; CLOSURE; FIBRILLATION; ANTICOAGULATION;

D O I：

10.4244/EIJV11I13A292

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Aims: 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. Methods and 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.

引用

页码：1512 / 1521

页数：10

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