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Published on: February 26, 2013
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Left atrial appendage occlusion with the Amplatzer Amulet: update on device sizing
Xavier Freixa1, Adel Aminian2, Apostolos Tzikas3
1Hospital Clinic de Barcelona, Institut Clínic Cardiovascular, Barcelona, Spain. xavierfreixa@hotmail.com.
Summary
Accurate left atrial appendage (LAA) assessment using imaging is crucial for device selection. Mean diameters may be superior to largest diameters with 3D imaging, but 2D imaging still benefits from largest diameter measurements for LAA sealing.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Cardiology
Background:
- Left atrial appendage (LAA) morphology assessment is key for effective sealing.
- Proper sealing minimizes manipulation and reduces complication risks during procedures.
Purpose of the Study:
- To analyze imaging modalities for LAA assessment.
- To recommend measurements for optimal Amulet device selection.
Main Methods:
- Consensus manuscript preparation by eight experienced physicians in LAA occlusion (LAAO).
- Comprehensive review of published data on LAA imaging and measurement.
Main Results:
- Complex LAA morphology necessitates 3D assessment for accurate sizing.
- 3D imaging suggests mean diameters are better than largest diameters, avoiding oversizing in elliptical LAA.
- CT yields larger measurements than 3D-TEE, 2D-TEE, and angiography.
- 2D imaging (2D-TEE, angiography) underestimates diameters; largest diameter remains best for sizing.
- Specific LAA anatomies (e.g., chicken-wing, conic) may require tailored measurements and implantation strategies.
Conclusions:
- LAA mean diameters are preferable with 3D imaging modalities.
- Largest diameters remain the best option for 2D imaging techniques.
