Thread by @DrJayMohan

1/ Had a great time writing this @EPLabDigest article with @DrCJBradley

tinyurl.com/mryk3cwe

2️⃣ different perspectives (IC And EP) using different devices (watchman/ amulet) for LAAC in the community center.

Let’s take a dive into two different LAAC programs #Tweetorial

2/ #LAAC has come a long way over the past few years and now we have two main players in the space

🔸 @bostonsci #watchman
🔸 @AbbottNews #Amulet

Both are very effective and each has pros/cons

My center focuses on Watchman FLX while @DrCJBradley center focuses on Amulet… twitter.com/i/web/status/1…

3/ Historically #EPeeps has taken the driver seat in this space (rightfully so) due to experience with the LA/transeptal. HOWEVER the new gen #IC/structuralist have become a vital part of the team.

#LAAC programs require:
📌Implanter
🔎Imager
🧑🏼‍⚕️Anesthesiologist/Cath lab team… twitter.com/i/web/status/1…

4/ the work up for #LAAC generally consists of:

➡️Patient selection: Inability to tolerate OAC
➡️Visit with implanter and objective observer

🪠Device implant occurs in the Cath lab (no hybrid room needed (unlike TAVR))

5/ imaging for #LAAC

For both our programs we have moved to a “Day of” TEE as most LAAC fit both devices.

TEE is performed before access to ensure sizing and no thrombus.

Occasionally CT is obtained prior to implant

#EchoFirst #CT #Cardiotwitter #Cardiology #EP #Afib… twitter.com/i/web/status/1…

6/ access

Both devices require fem vein access and transeptal puncture. Both our programs have utilized the Baylis RF system to cross the septum

The amulet has also utilized the Amplatzer 12-14F steerable delivery sheath and watchman has moved to the 12F VersaCross Connect.… twitter.com/i/web/status/1…

7/ Watchman FLX

🪂 The Watchman is a parachute-shaped device made out of a nitinol cage with a polyethylene terephthalate fabric membrane cap.

Watchman comes in 5️⃣ sizes (20-34)

💪🏽FLX has allowed easier placement compared to 2.5 and also tends to be considered a safer implant… twitter.com/i/web/status/1…

8/ Devices

🔗The Amulet occluder is a double-disc device consisting of a nitinol mesh with polyester fabric cover.

Amulet comes in 8️⃣ sizes (16-34)

⭐️ Amulet occluder has a shorter lobe length, which may facilitate placement in those with limited LAA depth or challenging… twitter.com/i/web/status/1…

9/ deployment

⚽️ The watchman FLX ball- part of device is formed and advanced safely

🏀 🔺The amulet ball and triangle- same concept but can transition to triangle for more depth

10/ Devices pros and cons

Watchman
🔹Easier implant/recapturable
🔹Fits most LAA
🔹Less effusions but more late device leaks? (2.5)

Amulet
🔸Multiple sizes, fits every LAA, less dependent on depth
🔸Only recapture 3 times
🔸Technically challenging
🔸More effusions but less… twitter.com/i/web/status/1…

11/ Imaging

Is is vital to have a dedicated structural heart imager for both devices.

Both devices seem to be more effectively implanted if guided by TEE compared to floro

#Echofirst #Cardiotwitter #Cardiology #EP #Afib #Watchman #Amulet @EchofirstB

12/ Follow up

Both devices DAPT post implant for 6 months

Watchman- 45 day TEE/or CT follow up

Amulet- 6 month TEE/or CT follow up

#Echofirst #Cardiotwitter #Cardiology #EP #Afib #Watchman #Amulet @EchofirstB

13/ Future directions

Some push to use ICE rather than TEE for implant as the patient can then be done with moderate sedation avoiding the need for anesthesia

Video courtesy of @Dr_Santangeli

Future directions

💝Both devices are effective and safe.

💰Optimally having the ability to implant each on a case by case basis would be optimal but price/contracts remains an issue.

🏥 Our experiences show that each program can be successful even with the limitation of one… twitter.com/i/web/status/1…

14/ Thanks

Thanks to both of our institutions for allowing us to share our experiences and also the the #Detroit cardiology community that continues to see strong collaboration in all aspects of cardiology!

May #EP AND #IC UNITE!

(@DrCJBradley and I as general fellows years… twitter.com/i/web/status/1…

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