ABC | Volume 113, Nº4, October 2019

Original Article Şahiner et al LAA occlusion with amulet device Arq Bras Cardiol. 2019; 113(4):712-721 Figure 3 – Patients’ follow-up. Left Atrial Appendage Occlusion n = 60 Periprocedural Mortalitiy n = 1 1 sy Month Visit n = 59 6 th Month Visit n = 57 12 th Month Visit n = 47 Mortality During Follow-up n = 2 Follow-up Duration under 12 months n = 10 of these studies still give us important information about the efficacy and safety of LAA occlusion with the Amulet device. In our series of 60 patients, the LAA occlusion procedure was successfully completed without major complications in 98.3% of cases. Our procedural success rate was similar to previous studies. 11-13 Landmesser et al. 12 reported that the procedural success of LAA occlusion with the Amulet device was 99.0% in their multicenter registry, which included 1,088 patients. 12 They reported peri-device leak in 2% of patients during follow-up. In accordance with these data, we identified significant peri-device leak (>3 mm) in two patients (3.3%) with TEE at the 1 st month after the procedure. 12 However, they showed no significant peri‑device leak at the 6 th month. We considered that this result might be due to the continued endothelization process on the closure device until six months after the procedure. We found no significant disabling CVEs during follow-up. Only two patients had TIA, but with no neurological sequelae, and their cranial imaging did not reveal significant ischemic lesions. On the other hand, previous multicenter registries showed that there is still a risk of thromboembolic events despite LAA occlusion. Regueiro et al. 14 recently reported that 7 out of 101 patients (6.9%) had a stroke after LAA occlusion in 4.2 years of follow-up, 6 of them related to thromboembolic events. 14 AMPLATZER cardiac plug constituted most of the devices used in this study (82%), while Amulet was used only in 3 patients. They discharged 70% of the patients under DAPT and those using a single antiplatelet agent. We used the Amulet device in all our patients and discharged 96% of the patients with DAPT, which continued up to 6 months after LAA occlusion. This fact might be one of the reasons for the low incidence of CVEs in the follow-up of our patient group. The relatively short follow-up duration and the smaller sample size in our study could also be reasons for this difference. DRT has been reported in 0-17% of patients after LAA occlusion. 15 Recently, some concern has been raised that DRT formation after LAA occlusion may be more frequent than expected. Fauchier et al. 16 reported that, among 469 patients who underwent LAA occlusion, the incidence of DRT was 7.2% in imaged patients during a mean follow‑up of 13 ± 13 months. 16 Thrombus over the device was an independent predictor of ischemic events. The Watchman device constitutedmost (58%) of devices used for LAA occlusion in this study, while the Amulet device was used in 97 patients. Interestingly, DAPT at discharge was associated with a lower risk of thrombus, and only 23.2% of the study group was discharged with this treatment. Costa et al. 17 published patient outcomes over a 12-month follow-up and found no DRT. 17 We did not observe DRT in our patients with TEE imaging at the 1 st , 6 th , and 12 th month after LAA occlusion, corroborating their results. 17 There is some controversy among studies regarding thrombus formation over the device. The individualized antiplatelet 717