Combination of an OMEGATM LAA-occluder with the Amplatzer AmuletTM Delivery Sheath for Complex LAA Device Closure

Introduction: HInterventional Left Atrial Appendage Occlusion (LAAO) has been established as an alternative to Oral Anticoagulation (OAC) in patients with Atrial Fibrillation (Afib) at high stroke risk and competing bleeding risk factors.The complexity of LAAO procedures depend on the anatomy of the LAA itself, its relation to the surrounding anatomical structures, and device specific properties.We present the case of a 90-year-old male, who was referred to our center for LAAO.The anatomy of the LAA was suitable for the use of a lobe-disc OMEGA-Device.However, coaxial placement of the occluder was not possible with the pre-shaped device sheath.After several unsuccessful attempts we adapted our interventional strategy by combining the unique features of the OMEGA-Device with the favourable characteristics of a 14Fr-double curve Amulet-Delivery-Sheath.This finally allowed for an optimal positioning of the 18mm-OMEGA-Device in the preselected landing zone with the intended perfect sealing of the LAA ostium.This case nicely demonstrates potentially important interdependency of structural cardiac interventions with device specific characteristics.