(A-B) the ACP device consists of a lobe and a disk connected by a short, flexible waist. (A-B) the ACP device consists of a lobe and a disk connected by.

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(A-B) the ACP device consists of a lobe and a disk connected by a short, flexible waist. (A-B) the ACP device consists of a lobe and a disk connected by a short, flexible waist. Both the lobe and disk are constructed from a nitinol mesh covered with a polyester patch. The lobe is implanted within the neck of the LAA (the so-called ‘landing zone’), and achieves device stabilization and retention by means of a number of stabilization wires. The delivery system is 9-13Fr depending on the size of the device. The lobe size ranges from 16-30 mm and the disk from 20–36 mm; the size of the lobe should be chosen 3 to 5 mm larger than the diameter of the ‘landing zone’. The ACP device is not designed to fill the LAA but to seal its ostium by means of the larger disk. As such, the ACP device could be a better choice when challenged with a more complex anatomy of the distal LAA or a proximal LAA lobe. The ACP device received a CE mark in 2008 and is currently used in clinical practice. (C-D) show the implantation of an ACP device in the regular way (C), or using the ‘sandwich technique’ when confronted with a chicken wing LAA with a short neck (D). (E) a cine image of a LA angiogram performed through a transseptal catheter following deployment of an ACP device (white arrow) inside the LAA - when properly positioned, the lobe has a typical ‘tire’ morphology with slight compression on the sides. (F) a TEE image of a properly deployed ACP device, showing absence of peri-device leaks, good alignment of the disk with the LA cavity, and absence of compression on the left upper pulmonary vein. Some images were reproduced with permission from Aryana et al. (2012).42 O De Backer et al. Open Heart 2014;1:e000020 ©2014 by British Cardiovascular Society