Interventions for hypertension and stroke

WATCHMAN versus ACP or Amulet devices for left atrial appendage occlusion: a sub-analysis of the multicentre LAARGE registry

EuroIntervention 2020;16:e942-e949. DOI: 10.4244/EIJ-D-19-01027

Jakob Ledwoch
Jakob Ledwoch1, MD; Jennifer Franke1, MD; Ibrahim Akin2, MD; Volker Geist3, MD; Christian Weiß4, MD; Uwe Zeymer5, MD; Sven Pleger6, MD; Matthias Hochadel7, MD; Harald Mudra8, MD; Jochen Senges7, MD; Thorsten Lewalter9, MD; Johannes Brachmann10, MD; Horst Sievert1,11, MD
1. CardioVascular Center CVC, Frankfurt, Germany; 2. I. Medizinische Klinik, Universitätsmedizin Mannheim, Mannheim, Germany; 3. Heart Center, Segeberger Kliniken GmbH, Bad Segeberg, Germany; 4. Städtisches Klinikum Lüneburg, Lüneburg, Germany; 5. I. Medizinische Klinik B, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany; 6. Innere Medizin III, Universitätsklinikum Heidelberg, Heidelberg, Germany; 7. Stiftung Institut für Herzinfarktforschung (IHF), Ludwigshafen, Germany; 8. Klinik für Kardiologie, Pneumologie und Intern. Intensivmed., Klinikum Neuperlach, Munich, Germany; 9. Peter Osypka Heart Center Munich, Munich, Germany; 10. Medizinische Klinik II, Klinikum Coburg, Coburg, Germany; 11. Anglia Ruskin University, Chelmsford, United Kingdom

Aims: Several left atrial appendage (LAA) closure systems are available. Due to differences in device design, the results of specific occluders derived from trials cannot simply be generalised to all devices. The present analysis sought to assess two contemporary LAA closure devices in clinical practice.

Methods and results: The work represents a non-randomised sub-analysis of the prospective, multicentre, Left-Atrium-Appendage Occluder Register - GErmany (LAARGE) registry. The WATCHMAN (group 1) and the AMPLATZER Cardiac Plug (ACP) or Amulet occluder (group 2) were assessed. A total of 641 patients at 38 centres were enrolled. Of these, 278 (43%) and 340 (53%) patients received the WATCHMAN and ACP/Amulet occluder, respectively. High technical success was achieved with a slight difference between the groups (96% in group 1 vs 99% in group 2; p=0.007). Procedural safety did not differ (98% in group 1 vs 97% in group 2; p=0.55). The Kaplan-Meier estimated one-year composite of death or stroke was 12.0% and 12.9%, respectively (p=0.79).

Conclusions: Both the WATCHMAN and the ACP/Amulet occluder provide excellent procedural results with comparable implantation success and no differences with respect to procedural safety and long-term effectiveness.

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Interventions for strokeLAA closure
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