Amulet (Left Atrial Appendage Closure) · EP Patient Education Library

Same goal, different design

Amulet is built around the same idea as WATCHMAN: in non-valvular atrial fibrillation, more than 90% of stroke-causing clots originate in the left atrial appendage, and sealing off that single pouch can dramatically reduce stroke risk while letting most patients come off long-term blood thinners. Where it differs is in how it closes the appendage.

WATCHMAN is essentially a single-component plug — a parachute-shaped device that sits inside the appendage opening and depends on tissue growing across its fabric face to complete the seal.

Amulet uses two components that work together:

An inner lobe, similar in concept to a single-component plug, anchors inside the body of the appendage.
An outer disc, attached to the lobe by a short waist, opens on the atrial side of the appendage opening and covers it like a lid.

The disc seals the appendage from outside the opening, while the lobe holds the system in place from within. The benefit of this two-part design is that the appendage opening is effectively sealed at the moment of implant — by mechanical coverage from the disc — rather than depending entirely on slow tissue ingrowth. That can shorten the post-implant medication course and, in some patients, simplify the transition off long-term anticoagulation.

The currently FDA-approved Amulet device in the United States is the Abbott Amplatzer Amulet.

Why a different design exists

Left atrial appendages vary tremendously in shape — short, long, multi-lobed, chicken-wing, cactus, windsock. Some appendages are easy to seal with a single-component plug; others have ostia (openings) that are large, oval, or angled in ways that make a clean seal harder. The lobe-and-disc design tolerates more anatomic variation, because the disc on the atrial side can cover an opening even when the lobe inside doesn’t perfectly fill every recess of the pouch. In practice this widens the range of appendage shapes that can be sealed reliably.

How the procedure compares

From the patient’s perspective, the implant feels very similar to WATCHMAN: general anesthesia, a transesophageal echo for imaging, vein access in the groin, a small puncture across the wall between the atria, and a device delivered through a sheath into the appendage. The Amulet system has its own delivery and deployment steps — the lobe is positioned and anchored first, then the disc is opened and the seal is checked from both surfaces before release. Procedure time is similar.

The post-implant medication plan is the most noticeable practical difference. With WATCHMAN, the standard course includes anticoagulation for about 45 days, then a transition usually to aspirin after a TEE confirms seal. With Amulet, the typical course is aspirin plus a second antiplatelet (clopidogrel) for a period, then aspirin alone — many patients do not require a continued course of oral anticoagulation after implant. The exact regimen is chosen based on bleeding risk, kidney function, and what we see at imaging.

Who is a candidate

The patient profile is essentially the same as WATCHMAN: non-valvular atrial fibrillation with a meaningful stroke risk and a specific reason that long-term anticoagulation is problematic — a prior major bleed, recurrent bleeding on anticoagulation, intracranial hemorrhage, frequent falls with traumatic bleeding, or an occupation or lifestyle that makes daily anticoagulation impractical or dangerous.

Amulet may be preferred over WATCHMAN when:

The appendage anatomy is challenging for a single-component plug — particularly large ostia or unusual shapes.
We specifically want to avoid a post-implant oral anticoagulant course because the bleeding risk is too high to tolerate even 45 more days.
Prior closure attempts or anatomic considerations suggest a two-component seal will work better.

Both devices have strong outcomes data behind them, and the choice often comes down to anatomy, bleeding profile, and operator experience. For many patients, either device would be reasonable; we walk through the trade-offs at the visit.

What it doesn’t change

Like any LAA closure device, Amulet addresses the appendage clot pathway in AFib — the dominant stroke pathway in non-valvular disease. It does not treat the AFib rhythm itself (rate control and rhythm strategies are separate decisions), and it does not protect against clots from other sources. Patients with mechanical valves, rheumatic mitral stenosis, or clots already present in the appendage at evaluation are not candidates. As with WATCHMAN, the decision should sit inside a full picture of your stroke risk, your bleeding history, your other medical issues, and your preferences — and we go through all of that together.

Manufacturer reference

For technical specifications, indications, and the latest official information on the Amplatzer Amulet system from its maker, see Abbott’s product page: Amplatzer Amulet LAA Occluder on cardiovascular.abbott. (External link — content there is Abbott’s and may be technical.)

Watch

Short videos to help illustrate this topic. Embedded from the original channels — content belongs to them.

Video pending Add a youtube video ID to display: Abbott Amplatzer Amulet — device overview

Abbott Amplatzer Amulet — device overview · Abbott (official) · Paste the official YouTube ID here.

Video pending Add a youtube video ID to display: Abbott Amplatzer Amulet — implant animation

Abbott Amplatzer Amulet — implant animation · Abbott (official) · Paste the official YouTube ID here.

Informed Consent — At a Glance

A plain-English summary of what we discuss before this procedure. This is not a substitute for the formal consent conversation with Dr. Colombowala.

Benefits

✓Reduces AFib-related stroke risk by closing the left atrial appendage.
✓Two-part lobe-and-disc design seals the appendage from inside and outside, often achieving a complete seal at the time of implant.
✓Allows most patients to avoid long-term oral anticoagulation, typically with a shorter post-implant blood-thinner regimen than other closure devices.
✓One-time implant, no ongoing daily anticoagulant for the appendage-related stroke pathway.

Risks

⚠Bleeding or bruising at the groin access site (common, almost always minor).
⚠Vascular injury at the groin (~1%).
⚠Cardiac perforation or pericardial effusion — fluid around the heart (~1%); risk is slightly higher than with single-lobe devices because of the disc deployment.
⚠Stroke or TIA at the time of the procedure (~0.5%).
⚠Device-related thrombus — a small clot forming on the atrial-facing disc; usually managed with a short course of anticoagulation.
⚠Peri-device leak — usually small and inconsequential, sometimes requires continued anticoagulation.
⚠Device embolization or migration — rare.
⚠Air embolism or arrhythmias during the procedure.

Alternatives

↔Continued long-term oral anticoagulation (DOAC or warfarin) — the standard for most AFib patients.
↔WATCHMAN — the longer-established percutaneous LAA closure device with a single-component plug design.
↔Surgical or thoracoscopic LAA closure.
↔Accepting stroke risk without anticoagulation — only when bleeding risk clearly outweighs stroke risk and no closure option is feasible.

During the procedure

You'll be under general anesthesia in most cases. A transesophageal echo probe is placed for continuous high-resolution imaging of the appendage. Catheters are advanced through a vein in the groin, up to the right atrium, and across into the left atrium. The Amulet's inner lobe is deployed inside the appendage and anchored, then the outer disc is opened on the atrial side to cover the appendage opening. We confirm both parts are well-seated, fully sealing the appendage and stable, before releasing the device. Total lab time is typically 60–90 minutes.

Recovery

Most patients go home the same day or after one night. Light activity in 1–2 days; avoid heavy lifting and strenuous exercise for about a week while the groin heals. Post-implant medications most commonly include aspirin plus clopidogrel (a second antiplatelet) for a defined period, then aspirin alone — many patients do not need a long oral anticoagulant course after Amulet. A transesophageal echo at a few months confirms seal, position, and absence of device-related clot.