AMPLATZER™ Amulet™ LAA Occluder Trial

The Amulet IDE trial is a prospective, randomized, multi-center active control worldwide
trial, designed to evaluate the safety and effectiveness of the AMPLATZER™ Amulet™ Left
Atrial Appendage Occluder. Subjects will be randomized in a 1:1 ratio between the Amulet LAA
occlusion device (treatment) or a Boston Scientific WATCHMAN® LAA closure device (Control).
The trial will be conducted at up to 150 sites worldwide. All enrolled subjects will follow
the protocol-required tests and assessments at each scheduled follow-up visit.

Inclusion Criteria:

1. 18 years of age or older

2. Documented paroxysmal, persistent, or permanent non-valvular atrial fibrillation (AF)
and the patient has not been diagnosed with rheumatic mitral valvular heart disease

3. At high risk of stroke or systemic embolism defined as CHADS2 score > 2 or a
CHA2DS2-VASc score of ≥ 3

4. Has an appropriate rationale to seek an alternative to warfarin or other
anticoagulation medication

5. Deemed by investigator to be suitable for short term warfarin therapy but deemed
unable to take long term oral anticoagulation following the conclusion of shared
decision making (see inclusion criteria #6)

6. Deemed suitable for LAA closure by a multidisciplinary team of medical professionals
(including an independent non-interventional physician) involved in the formal and
shared decision- making process, and by use of an evidence-based decision tool on oral
anticoagulation (final determination must be documented in the subject's medical
record)

7. Able to comply with the required medication regimen post-device implant

8. Able to understand and willing to provide written informed consent to participate in
the trial

9. Able to and willing to return for required follow-up visits and examinations

Exclusion Criteria:

1. Requires long-term oral anticoagulation therapy for a condition other than atrial
fibrillation

2. Contraindicated for or allergic to aspirin, clopidogrel, or warfarin use

3. Indicated for chronic P2Y12 platelet therapy inhibitor

4. Has undergone atrial septal defect (ASD) repair or has an ASD closure device implanted

5. Has undergone patent foramen ovale (PFO) repair or has a PFO closure device implanted

6. Implanted with a mechanical valve prosthesis

7. Has any of the customary contraindications for a percutaneous catheterization
procedure (e.g. subject is too small to accommodate the transesophageal echocardiogram
(TEE/TOE) probe or required catheters, or subject has active infection or bleeding
disorder)

8. Stroke or transient ischemic attack (TIA) within 90 days prior to randomization or
implant procedure (as applicable)

9. Underwent any cardiac or non-cardiac intervention or surgery within 30 days prior to
randomization, or intervention or surgery is planned within 60 days after implant
procedure (cardioversion, ablation, cataract surgery, etc.)

10. Myocardial infarction (MI) within 90 days prior to randomization

11. New York Heart Association Class IV Congestive Heart Failure

12. Left ventricular ejection Fraction (LVEF) <30%

13. Symptomatic carotid artery disease (defined as >50% stenosis with symptoms of
ipsilateral transient or visual TIA evidenced by amaurosis fugax, ipsilateral
hemispheric TIAs or ipsilateral stroke); if subject has a history of carotid stent or
endarterectomy the subject is eligible if there is <50% stenosis

14. Reversible cause of AF (i.e. secondary thyroid disorders, acute alcohol intoxication,
trauma, recent major surgical procedures)

15. History of idiopathic or recurrent venous thromboembolism

16. Left atrial appendage is obliterated or surgically ligated

17. Resting heart rate >110 bpm

18. Thrombocytopenia or anemia requiring transfusions

19. Hypersensitivity to any portion of the device material or individual components of
either the Amulet or Boston Scientific LAA closure device (e.g. nickel allergy)

20. Actively enrolled or plans to enroll in a concurrent clinical study in which the
active treatment arm may confound the results of this trial

21. Subject is pregnant or pregnancy is planned during the course of the investigation

22. Active endocarditis or other infection producing bacteremia

23. Subject has had a transient case of AF (i.e. never previously detected,
provoked/induced by surgical or catheter manipulations, etc.)

24. Subjects with severe renal failure (estimated glomerular filtration rate
<30ml/min/1.73m²

25. Subject whose life expectancy is less than 2 years

26. Presence of other anatomic or comorbid conditions, or other medical, social, or
psychological conditions that, in the investigator's opinion, could limit the
subject's ability to participate in the clinical trial or to comply with follow up
requirements, or impact the scientific soundness of the clinical trial results.