AHEPA University Hospital, Thessaloniki, Greece.
EuroIntervention. 2016 Apr 20;11(13):1512-21. doi: 10.4244/EIJV11I13A292.
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.
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.
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.
本文旨在描述使用 AMPLATZER Amulet 装置进行左心耳封堵（LAAO）的标准化方法，并为不同经验水平的操作者提供有用的技巧和窍门。
我们邀请了 LAAO 方面的专家以及具有 AMPLATZER Amulet 装置临床经验的医师参与本共识文件的编写。来自 14 个不同国家的 27 名医师（20 名介入心脏病专家和 7 名电生理学家）对本文进行了审阅。我们遵循了一种逐步的方法，模拟了一个真实的病例。首先是患者选择和规划，讨论了相关的心脏影像学检查，然后是血管入路 - 房间隔穿刺的优化。接下来，解释了血管造影校准/测量和所需的透视视图，并提出了一种设备尺寸选择策略。简要描述了设备准备和除气，然后是鞘管交换、设备部署步骤、设备稳定性评估和最终释放的决策。接下来展示了如何重新捕获和更换设备，以及一些处理具有挑战性的解剖结构（如“鸡翅”状左心耳）的额外技巧。最后，对于从 AMPLATZER 心脏塞转换为 Amulet 的操作者，我们介绍了两种设备在植入技术方面的主要区别。
总之，本文反映了专家操作者对 LAAO 技术步骤的共识方法，以及 AMPLATZER Amulet 装置植入的最佳实践，以及一些实用的技巧，以最大限度地降低并发症发生率。
