Transcatheter Left Atrial Appendage Occlusion Using Amulet and WATCHMAN Devices: A Five-Year Single-Centre Experience

Q: What are the key findings of this study?

Transcatheter LAAO achieved 86.9% overall implantation success, with WATCHMAN having shorter procedure duration and fewer complications than Amulet.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Atrial fibrillation with contraindication to long-term oral anticoagulation or high bleeding risk (n=84). Intervention: Transcatheter left atrial appendage occlusion with WATCHMAN device vs. Transcatheter left atrial appendage occlusion with Amplatzer Amulet device. Primary outcome: Device implantation success in LAAO-only procedures (p=0.473).

Vedran Pašara; Vlatka Rešković Lukšić; Sandra Jakšić Jurinjak; Ivan Prepolec; Andrija Nekić; Dejan Došen; Davor Miličić; Vedran Velagić

doi:10.15836/ccar2026.234

November 1, 2026Cardiologia CroaticaOpen Access

Transcatheter Left Atrial Appendage Occlusion Using Amulet and WATCHMAN Devices: A Five-Year Single-Centre Experience

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Key result

WATCHMAN is linked to ~17-point fewer complications and shorter procedure times than Amulet during LAAO.

P=0.473
n=84

Why the study?

Does transcatheter left atrial appendage occlusion with WATCHMAN compared to Amplatzer Amulet improve procedural characteristics, implantation success, and periprocedural safety through hospital discharge in patients with atrial fibrillation?

Key Points

To report five-year single-centre procedural outcomes, acute implantation success, and complication rates of transcatheter left atrial appendage occlusion using Amplatzer Amulet and WATCHMAN devices.
Retrospective observational study reviewing all attempted left atrial appendage occlusion (LAAO) procedures (N = 84) performed between June 2021 and October 2026 at a single centre.
Patients received either Amulet (n = 37; 44%) or WATCHMAN (n = 47; 56%) devices; 22 patients (26%) underwent concomitant pulmonary vein isolation.
Procedural characteristics, acute implantation success, and in-hospital complications through discharge were compared specifically between devices in LAAO-only procedures (Amulet, n = 36; WATCHMAN, n = 26).
Implantation was successful in 73 of 84 attempted procedures (86.9%), with failures driven primarily by unfavorable anatomy; nine adverse events occurred across eight patients (9.5%), including six access-site hematomas >5 cm, two arteriovenous fistulas, and one pericardial effusion.
Among LAAO-only procedures, WATCHMAN had a shorter median procedure duration than Amulet (43 [IQR 38–54] vs 60 [IQR 50–75] min; p < 0.001), while fluoroscopy time (5.2 vs 6.0 min; p = 0.199), radiation dose (318 vs 328 mGy; p = 0.451), and implantation success (80.8% vs 88.9%; p = 0.473) did not differ significantly.
Complications in LAAO-only cases occurred in six Amulet patients (16.7%) compared with zero WATCHMAN patients (p = 0.035), with five of seven overall Amulet-related adverse events occurring during the initial 2021–2022 implementation period.

Study Design

Type

Observational (n=84)

Multicenter

No

Structured PICO

Does transcatheter left atrial appendage occlusion with WATCHMAN compared to Amplatzer Amulet improve procedural characteristics, implantation success, and periprocedural safety through hospital discharge in patients with atrial fibrillation?

P

Population

84 older adults (mean age 72.3 years, 40% female) with atrial fibrillation and predominantly prior clinically significant bleeding undergoing attempted transcatheter LAAO, followed through hospital discharge.

E

Exposure

Transcatheter left atrial appendage occlusion (LAAO) using Amplatzer Amulet (n=37 total, n=36 LAAO-only) or WATCHMAN (n=47 total, n=26 LAAO-only) devices.

C

Comparator

Comparison between Amplatzer Amulet (n=36) and WATCHMAN (n=26) devices in LAAO-only procedures (excluding concomitant PVI).

O

Outcome

Procedural characteristics (procedure duration, fluoroscopy time, radiation dose), acute implantation success, and periprocedural complications through hospital discharge.safety

Main Result

Absolute Event Rate: 80.8% vs 88.9%

p-value: p=0.473

This five-year single-centre experience demonstrates high acute implantation success (86.9%) for transcatheter LAAO with both Amulet and WATCHMAN devices, with predominantly vascular access-site complications and shorter procedure times with WATCHMAN.

Limitations

Retrospective single-centre observational design
Small sample size (84 patients total, 62 in LAAO-only comparison)
Differences in procedural outcomes between devices may partly reflect the operator learning curve during the early years of the programme
Retrospective observational single-centre design
Learning curve associated with the early years of the programme may partly account for differences in procedural outcomes between devices

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Implication

Hypothesis-generating for WATCHMAN advantages in LAAO; leaves open confirmation in randomized trials.

Abstract

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Discussion

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Cite This Study

Pašara et al. (2026) conducted an observational in Atrial fibrillation with contraindication to long-term oral anticoagulation or high bleeding risk (n=84). Transcatheter left atrial appendage occlusion with WATCHMAN device vs. Transcatheter left atrial appendage occlusion with Amplatzer Amulet device was evaluated on Device implantation success in LAAO-only procedures (p=0.473). Transcatheter LAAO achieved 86.9% overall implantation success, with WATCHMAN having shorter procedure duration and fewer complications than Amulet.

synapsesocial.com/papers/6af5db330766bb45ea003111 https://doi.org/10.15836/ccar2026.234

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Transcatheter Left Atrial Appendage Occlusion Using Amulet and WATCHMAN Devices: A Five-Year Single-Centre Experience

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Transcatheter Left Atrial Appendage Occlusion Using Amulet and WATCHMAN Devices: A Five-Year Single-Centre Experience

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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