Abstract
The Amplatzer Cardiac Plug (ACP) is one of the most commonly used devices for percutaneous left atrial appendage (LAA) closure in order to prevent a stroke in patients with atrial fibrillation and contraindication for long-term oral anticoagulation therapy. We have previously described a patient who had experienced an embolization of the ACP device about 12 months after implantation and the device could be percutaneously retrieved. A few years later, he suffered from a posterior stroke and a stroke located in the brainstem as well as a transischemic attack (TIA). In order to protect him from further cardioembolic events a reocclusion of the LAA with the new generation of ACP device, the Amplatzer Amulet, was performed. A stable position of the device within follow-up period could be confirmed and the patient was free of additional strokes/TIA or bleeding events. This case stresses the importance of proper LAA sizing in order to prevent device embolization and notes that LAA size is not static. Moreover, it demonstrates that repeated implantation of an LAA occlusion device was still possible; one should be aware of undersizing the LAA dimensions and that the modifications of new generation LAA occlusion devices may overcome limitations of first-generation devices in order to prevent a cardioembolic stroke.
Highlights
The existing case reports and a recently published study with 17 patients described the implantation of the new Amulet device in the normal context of a single implanted left atrial appendage (LAA) device [3–5]
It was the second device in the same patient after the embolization of the initially implanted Amplatzer Cardiac Plug (ACP) device
We had a longer follow-up period with transesophageal echocardiography (TEE) controls compared to previously published reports. This case stresses the importance of proper LAA sizing in order to prevent possible device embolization
Summary
The Amplatzer Cardiac Plug (ACP; St. Jude Medical) is one of the most commonly used devices for percutaneous left atrial appendage (LAA) closure in order to prevent a stroke in patients with atrial fibrillation and contraindication for longterm oral anticoagulation therapy. We have previously published a paper describing a 75year-old patient who had experienced an embolization of the ACP device about 12 months after implantation [1]. A new generation of ACP device, the Amplatzer Amulet, has been made commercially available. The main concept of the Amulet device is based on the first generation of ACP with a distal lobe and a proximal disk connected by an articulating waist. The modifications of the Amulet device include new features to facilitate device deployment and to reduce the embolization risk [3]. The experiences with the new Amulet device are limited so far [3–5]
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