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 4 – Computed tomography image of the neighborhood between pulmonary artery and left atrial appendage. to show the performance of LAA occlusion with the Amulet device. Third, we performed LAA occlusion in different clinical scenarios, such as thrombus formation in the LAA. There are some studies about these challenging conditions and the safety of LAA occlusion. Our series had similar results to those found in the literature. Due to the lack of consensus on adjuvant antithrombotic therapeutic strategies, we individualized the antiplatelet therapy after the procedure. However, our study population was relatively small for us to recommend an antithrombotic regimen after the procedure. Large-scale studies are necessary to make such recommendations. Conclusion LAA occlusion is an important and effective therapeutic option for selected AF patients with an increased risk of bleeding with anticoagulant treatment. Nevertheless, the procedure has some significant periprocedural risks, including death. Consequently, LAA occlusion should be performed in carefully selected patients with increased thromboembolic risk, who have at least one-year survival expectation and cannot tolerate OACs or had clinically important bleeding events. Since LAA occlusion can be a challenging procedure, it should be performed by experienced operators with optimal skills and in collaboration with a heart team, including surgeons, neurologists, and experts on cardiovascular imaging. Author contributions Conception and design of the research: Şahiner ML; Acquisition of data: Şahiner ML, Kaya EB; Analysis and interpretation of the data: Kaya EB; Statistical analysis: Kaya EB, Çöteli C; Writing of the manuscript: Şahiner ML, Çöteli C; Critical revision of the manuscript for intellectual content: Aytemir K. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associatedwith any thesis or dissertationwork. Ethics approval and consent to participate This study was approved by the Ethics Committee of the Hacettepe Universitesi Tip Fakultesi under the protocol number LUT/66. All the procedures in this study were in accordance with the 1975 Helsinki Declaration, updated in 2013. Informed consent was obtained from all participants included in the study. 719