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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Cardiac Plug I and Amulet Devices: Left Atrial Appendage Closure for Stroke Prophylaxis in Atrial Fibrillation
Akhil Parashar1, E Murat Tuzcu2, Samir R Kapadia2
1Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH.
Insights
Percutaneous left atrial appendage (LAA) occlusion offers stroke prevention for high-risk atrial fibrillation patients. This review details Amplatzer devices, focusing on their design, implantation, and recent evidence.
Area of Science:
- Cardiology
- Medical Devices
- Interventional Cardiology
Background:
- Percutaneous left atrial appendage (LAA) occlusion is a key stroke prophylaxis for non-valvular atrial fibrillation (NVAF) patients unsuitable for anticoagulation.
- Amplatzer devices have a decade-long history in LAA occlusion, evolving from repurposed devices to dedicated implants like the Cardiac Plug (ACP) and Amulet.
- While WATCHMAN is FDA-approved in the US, Amplatzer devices (ACP, Amulet) are widely used globally, with evidence primarily from registry data.
Approach:
- This article reviews the device design and implantation techniques for the Amplatzer Cardiac Plug 1 and the second-generation Amulet device.
- It synthesizes the most recent published evidence for these Amplatzer LAA occlusion devices.
- The review aims to clarify the current role and evidence base of Amplatzer devices in percutaneous LAA occlusion.
Key Points:
- Amplatzer Cardiac Plug 1 and Amulet devices are designed for LAA occlusion in NVAF patients.
- Evidence for Amplatzer devices largely stems from multicenter registry data, contrasting with randomized trial data for other devices.
- The Amulet device features enhanced stability mechanisms compared to its predecessors.
Conclusions:
- Amplatzer devices are significant tools in the expanding field of percutaneous LAA occlusion.
- Understanding their design, implantation, and evolving evidence is crucial for clinicians.
- Further research may clarify the comparative effectiveness of Amplatzer devices against other LAA occlusion strategies.
Abstract:
Percutaneous 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, however in the US only the WATCHMAN device has been FDA approved. 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. In this 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.
