{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T09:33:00Z","timestamp":1790415180613,"version":"4.1.0"},"reference-count":24,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T00:00:00Z","timestamp":1747612800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Watchman FLX (W\u2010FLX) is the most widely used left atrial appendage occlusion (LAAO) device to prevent atrial fibrillation (AF) related strokes in the United States.\u202fHowever, successful LAAO with W\u2010FLX can be challenging in patients with complex left atrial appendage (LAA) anatomies. This analysis aimed to assess the procedural success rates of LAA occlusion (immediate and short\u2010term outcomes) using the Amulet device, in patients with prior failed LAAO with W\u2010FLX device.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and Results<\/jats:title><jats:p>This was a multicentric retrospective analysis of 62 consecutive patients with unsuccessful LAAO with W\u2010FLX, who subsequently underwent an attempted Amulet occluder placement. The primary endpoint was successful Amulet implantation. Secondary endpoints included peri\u2010device leak (PDL) and device\u2010related thrombus assessed by transesophageal echocardiography (TEE) at 45 days, safety end point through 7 days or hospital discharge (whichever was later) and major adverse events (MAEs) through 45 days. The Amulet occluder was successfully implanted in 98.38% of patients (<jats:italic>n<\/jats:italic>\u2009=\u200961\/62). No clinically relevant PDL or device\u2010related thrombus was noted at 45 days. There was one pericardial effusion noted a week after Amulet implant that underwent successful percutaneous pericardiocentesis. The reasons for W\u2010FLX failure were all anatomical in nature. We identified five distinct anatomical patterns that posed challenges for W\u2010FLX deployment but were amenable to successful Amulet implantation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The disc\u2010lobe design of Amulet allows a high degree of successful LAAO in challenging anatomical variants (whale\u2010tail, bilobed LAA, shallow vertical chicken\u2010wing or seahorse, oval wide with posterior sloping trabeculations, and extensively trabeculated broccoli morphologies) with prior failed W\u2010FLX implants. These findings may help guide device selection on pre\u2010LAAO imaging, thereby enhancing resource utilization and contributing to more efficient and safer LAAO procedures.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.16729","type":"journal-article","created":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T06:07:02Z","timestamp":1747721222000},"page":"1632-1642","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Outcomes of Left Atrial Appendage Occlusion Treatment With Amulet After Unsuccessful Watchman FLX Device: A Multicenter Observational Study"],"prefix":"10.1111","volume":"36","author":[{"given":"Arindam","family":"Bagga","sequence":"first","affiliation":[{"name":"Arizona Heart Arrhythmia Associates Phoenix Arizona USA"},{"name":"Johns Hopkins University Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Sutherlin","sequence":"additional","affiliation":[{"name":"Arizona Heart Arrhythmia Associates Phoenix Arizona USA"},{"name":"Creighton University School of Medicine Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhavya","family":"Makkar","sequence":"additional","affiliation":[{"name":"Arizona Heart Arrhythmia Associates Phoenix Arizona USA"},{"name":"University of Arizona Tucson Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Spencer","family":"Green","sequence":"additional","affiliation":[{"name":"Arizona Heart Arrhythmia Associates Phoenix Arizona USA"},{"name":"Creighton University School of Medicine Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4421-3044","authenticated-orcid":false,"given":"Lakshmi Laasya","family":"Vallabhaneni","sequence":"additional","affiliation":[{"name":"Arizona Heart Arrhythmia Associates Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corinne","family":"Mitra","sequence":"additional","affiliation":[{"name":"Arizona Heart Arrhythmia Associates Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Abdelrahman","sequence":"additional","affiliation":[{"name":"Arizona Heart Arrhythmia Associates Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahesh","family":"Balakrishnan","sequence":"additional","affiliation":[{"name":"Arizona Heart Arrhythmia Associates Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Hantla","sequence":"additional","affiliation":[{"name":"Arizona Anesthesia Solutions Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1492-2693","authenticated-orcid":false,"given":"Dhanunjaya","family":"Lakkireddy","sequence":"additional","affiliation":[{"name":"Kansas City Heart Rhythm Institute and Research Foundation Overland Park Kansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7922-2564","authenticated-orcid":false,"given":"Akash","family":"Makkar","sequence":"additional","affiliation":[{"name":"Arizona Heart Arrhythmia Associates Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,5,19]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.04.029"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)61343-X"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2024.05.004"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2023.12.012"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euad237"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euae035"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.285.22.2864"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.09-1584"},{"issue":"23","key":"e_1_2_13_10_1","first-page":"01553","article-title":"First Experience With Amulet in the United States: Early Insights From Emerge LAA 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