In this session, chair Richard Schilling (London, UK) introduces case operator Devi Nair (St Bernards Heart & Vascular, Jonesboro, US) with panellists Bradley Knight (Chicago, US) and Shephal Doshi (Santa Monica, US). Devi Nair demonstrates left atrial appendage closure using the conformable AcuForm foam–nitinol system, highlighting its two-size design, shallow 10 mm landing zone and dual-row anchor configuration aimed at secure fixation with reduced collateral injury. The case walk-through covers pre-procedural imaging, simple sizing, transseptal technique and the use of a deflectable sheath to achieve coaxial alignment, followed by slow, controlled deployment, full recapture capability and immediate angiographic confirmation of complete occlusion.
The discussion reviews the growing clinical evidence base, including ongoing pivotal randomised Conform IDE trials comparing AcuForm with commercial devices, with long-term imaging follow-up out to five years. The panel explore real-world indications for left atrial appendage closure in patients intolerant of anticoagulation, the grey zone of relative contraindications, and the emerging practice of combining closure with atrial fibrillation ablation. They also address reasons for uneven global uptake, particularly the low implant numbers in the UK, and consider how fully occlusive foam-based designs, streamlined imaging workflows and more device choice could shape future practice.
