Asked following the formal presentation whether the results justify use of one device over the other for LAA occlusion, Dr. Lakkireddy said he likes the dual closure mechanism of the Amulet and is more likely to use it in patients with proximal lobes, very large appendages, or a relatively shallow appendage. “In the rest of the cases, I think it’s a toss-up.”
As for how generalizable the results are, he noted that the study tested the Amulet against the legacy Watchman 2.5 but that the second-generation Watchman FLX is available in a larger size and has shown improved performance.
The Amplatzer Amulet does not require oral anticoagulants at discharge. However, the indication for the Watchman FLX was recently expanded to include 45-day dual antiplatelet therapy as a postprocedure alternative to oral anticoagulation plus aspirin.
Going forward, the “next evolution” is to test the Watchman FLX and Amulet on either single antiplatelet or a dual antiplatelet regimen without oral anticoagulation, he suggested.
Results from SWISS APERO, the first randomized trial to compare the Amulet and Watchman FLX (and a handful of 2.5 devices) in 221 patients, showed that the devices are not interchangeable for rates of complications or leaks.
During a press conference prior to the presentation, discussant Federico Asch, MD, MedStar Health Research Institute, Washington, said, “the most exciting thing here is that we have good options. We now can start to tease out which patients will benefit best from one or the other because we actually have two options.”
The Amulet IDE trial was funded by Abbott. Dr. Lakkireddy reports that he or his spouse/partner have received grant/research support from Abbott, AtriCure, Alta Thera, Medtronic, Biosense Webster, Biotronik, and Boston Scientific; and speaker honoraria from Abbott, Medtronic, Biotronik, and Boston Scientific.
A version of this article first appeared on Medscape.com.