Amulet LAA Closure Device
In late 2021, the FDA approved the most recent LAA closure device, Abbott’s Amplatzer Amulet, a device with a strong track record of results in Europe and around the world. Shortly after that, Dr. Moretta was certified in its use and implantation. In general terms, it functions similarly to the Watchman left atrial occlusion device in that it covers the opening to the LAA and prevents blood clots from entering the heart. It is employed if patients cannot tolerate blood-thinning medication, the most effective stroke risk-reducing modality.
However, the Amulet device has one significant added benefit. It allows for the immediate closure of the LAA, meaning patients can stop their blood thinning medication right after the procedure. This contrasts with the Watchman, which requires about 45 days of anticoagulant therapy as the device is being enveloped by scar tissue. The difference lies in what the manufacturer calls dual seal technology.
How the Amulet Is Placed
Notably, the amulet LAA occlusion device comes in eight sizes, with a diameter of 16-34 millimeters, allowing for treating a wide range of anatomies. The Amulet is deployed from a catheter inserted into the body through a small incision in the groin and threaded up to the heart through a vein. Once deployed, the bath plug-shaped device fits snugly over the opening to the LAA, and tiny hooks around the perimeter of the device hold it in place. Acting as a filter, it immediately seals the LAA from the rest of the atrium, and it’s compelling enough that blood thinners can be discontinued immediately after placement.
How the Amulet Works
LAA closure aims to eliminate the possibility of blood clots leaving the LAA and entering the circulation system, potentially causing a stroke. While the Watchman device is very effective in doing so, the Amulet seems to have fewer instances of clot leaks after closure. Does this lead to fewer strokes? This is still under investigation. However, we welcome a device that shows less than half the moderate peridevice leakage rate at 45 days and a full year.
Risks and Considerations of the Amulet
As with any procedure, there are risks. The Amulet carries all the risks associated with a minimally invasive catheter-based procedure, including the potential for blood loss and infection at the catheter insertion site. Patients may rarely experience structural injury to blood vessels or the heart. Cardiovascular events such as stroke or heart attack are infrequent. While the Amulet occlusion device offers excellent protection from clot leaks at 45 days and one year after placement, there is still a risk of leaks that can lead to stroke. In other words, while this procedure is an excellent step in the right direction, we still do not yet have a 100% effective solution.
To learn more about the Amulet, we encourage you to schedule a consultation with doctor Moretta. We are excited to offer our patients this new generation of LAA occlusion devices. We look forward to helping you find out if this or any of our stroke risk reduction therapies may be appropriate for you.
