AFib is short for atrial fibrillation. It’s the most common heart rhythm disturbance. It affects millions of people. It can make some people feel poorly with the heart beating funny. But it increases the risk of stroke. Your risk of stroke, on average, is five times higher than the average population once you have atrial fibrillation.
Most atrial fibrillation patients need to be on blood thinners to prevent stroke. And that’s what...how most people are treated. However, every once in a while some patients have bleeding complications or are at increased risk of bleeding. For them a second option is something called the left atrial appendage occlusion. It’s a procedure that enables them to come off blood thinners eventually.
The procedure that is an option, an alternative, to blood thinning medication for patients allows them to still have protection against stroke, is called a Watchman. And it’s a device that can be put in the left atrial appendage of the heart. That is the part of the heart where blood clots typically form with patients in atrial fibrillation. So as an alternative to being on a blood thinner, it’s a device that can be put in there through a tube that is put in the vein in the leg. A tubing from there can be placed into this appendage. And the Watchman is a device that has a metal frame shaped like a parachute, with a material coating. Once the tubing is put into the appendage, that device can be compressed, run up through the tubing, put into the appendage. And when it’s in the proper location, through...which we define through imaging and ultrasound imaging of the heart, the tubing is simply pulled back to allow the device to expand out. When it’s expanded, it actually obliterates the blood flow into the appendage, so now there is no way for a blood clot to come out of that appendage. And actually over a period of time, in fact, the appendage is totally sealed so there’s no blood flow in there at all. Once that has been accomplished, then the only blood thinner that patients need long term is aspirin therapy.
So it’s an invasive procedure, where we’re putting something mechanical in your heart. The risk the day you have it done is in the 1% vicinity. That includes perforation of the heart, with bleeding around it or the device dislodging or stroke. But all the bad things together are about 1% the day of implant. Then patients need to be on blood thinners for a few weeks while the device heals. So during that time you’re still vulnerable for bleeding, which is why most patients get this device. So you take a small risk of bleeding for a few weeks to benefit from reducing risk of stroke and not need blood thinners long term.
After the procedure is done, most patients are in the hospital only for an overnight observation. And at that point can be discharged to home with pretty much getting back to normal routine and activity level. They stay on their blood thinners, usually aspirin and Coumadin, for up to 6 weeks. And then after 6 weeks we do another ultrasound study of the heart to make sure that the device has completely sealed the appendage. At that point, if it is confirmed, patients are taken off their Coumadin and then use another less aggressive blood thinner for a period of 4 months and at that point, simply on aspirin therapy alone. We typically do office visits with patients at 6 weeks after the implant and at 6 months and then yearly thereafter.
Patients coming to Spectrum can expect all aspects of their atrial fibrillation taken care of. We have a team of electrophysiologists that perform hundreds of ablations a year for patients who have symptoms from AFib. The risk of stroke can be addressed with blood thinners. Or a few of them will end up needing the Watchman device. And this multi-disciplinary approach will have patients better covered when they come to an institution, where we can take care of all those things at the same time.
