AF Symposium 2017
LIVE VIDEO! Two Procedures—Different Left Atrial Appendage (LAA) Occlusion Devices
This live streaming video session from Milan, Italy, featured two Left Atrial Appendage occlusion devices: the Amplatz Amulet from St. Jude Medical and the LAmbre from LifeTech Scientific.
LAA Closure Using the Amplatz Amulet (St. Jude Medical)
Live from Milan, Drs. Claudio Tondo, Antonio Dello Russo, Gaetano Fassini, and Massimo Moltrasio inserted an Amplatz Amulet (St. Jude Medical) into the Left Atrial Appendage of a 78-year-old women who had a high risk of bleeding. (The LAA is the origin of 90%-95% of Atrial Fibrillation-related clots).
Model of Patient’s LAA: These doctors did something I had never seen before. They made a physical model of the woman’s LAA, then showed how the Amplatz Amulet fit into the model. This isn’t done in all cases of LAA occlusion, but was very helpful for the AF Symposium attendees to see how the Amplatz Amulet actually worked.
The doctors also demonstrated how they could easily retract and recapture the device (which isn’t easy to do with the Watchman occlusion device [Boston Scientific]).
Like the Watchman device, the Amulet also has hooks to hold the device in place.
VIDEO ANIMATION: showing how the Amplatz Amulet device is installed (1:14 min.) from St. Jude Medical.
It seemed very easy to insert the Amplatz device. It closed off the LAA opening with the bottom part completely covering the LAA opening into the left atrium.
For most patients, this might be an advantage of the Amplatz device over the Watchman occlusion device which doesn’t have this overlap and can sometimes leak around the edges.
But, on the other hand, once the Amplatz device is in place, the overlap of the LAA would prevent ablation and electrical isolation of the LAA should that be necessary. But in most cases, this isn’t often required.
Second LAA Closure Using the LAmbre (LifeTech Scientific)
Later in the session when the moderators cut back to the live video stream from Milan, the EPs inserted a LAmbre (LifeTech Scientific) device in the LAA of a second patient. She was a 50-year-old woman who had a very small LAA. She had suffered two ischemic strokes within a month of each other, but she had bleeding problems when she took warfarin and dabigatran (Pradaxa).
[She was definitely between a rock and a hard place. Ischemia refers to a restriction or blocking of blood supply as by A-Fib clots. She needed to be on blood thinners to prevent A-Fib clots from forming particularly in her LAA, but couldn’t tolerate blood thinners which caused her bleeding problems. An LAA occlusion device was pretty much her only option.]
The LAmbre LAA occlusion device (LifeTech Scientific) seems similar to the Amplatz (St. Jude Medical) as both are fully recapturable and repositionable within the LAA. But each has its own anchor design to hold the device in place. But the LAmbre can fit into smaller size Left Atrial Appendages.
Both the Amplatz Amulet and the LAmbre occlusion devices are approved for use in Europe, but neither is approved yet in the U.S. (Not surprising since the U.S. approval of the Watchman device also lagged the European approval.)
I predict the Amplatz Amulet from St. Jude Medical will soon be approved by the FDA for use in the U.S.