Common Afib symptoms include an irregular heartbeat, fatigue, shortness of breath, dizziness, chest pain and fainting.
Of major concern is that people with Afib have a nearly fivefold risk of stroke compared to those without Afib, said Dr. Roy Robertson, an interventional cardiologist with Parkview Physicians Group Cardiology and president of Parkview Heart Institute.
The quivering heart allows blood to pool in the atria, particularly in the left atrial appendage, an out-pouch in the wall of the left atrium. The stagnant blood forms clots that can travel through the blood stream to the brain, causing a stroke. To reduce risk for stroke, Afib patients are commonly prescribed blood thinners.
Patients with Afib who meet certain criteria now have a new treatment available at Parkview Heart Institute. The Watchman implant is lowering the risk of stroke in patients with Afib that is not related to heart valve issues.
BARRIER TO CLOTS
The first U.S. Food & Drug Administration-approved device of its kind, the Watchman is also freeing Afib patients from a lifetime of blood-thinning medications, which carry their own serious risks. Blood thinners require ongoing monitoring of the blood to ensure it does not become too thin and lead to internal bleeding or excessive bleeding at an injury site. Even a seemingly minor fall can be devastating.
“Ninety percent of people (with Afib) who develop clots will develop them in the left atrial appendage,” Robertson said. “Anytime you have a blood clot, it can grow. They can be irregular and fall apart, like when you make a snowman and you make it too big,” he explained.
Pieces of clots fall out of the appendage and into the left atrium, eventually traveling in the blood stream to the brain, causing a stroke which leads to disability and sometimes death. The Watchman serves as a barrier that prevents pieces of clots from moving from the left atrial appendage into the main part of the left atrium.
About four years ago, Ronald Long, 75, who, with his wife, Judy, spends summers on Hamilton Lake in Steuben County and winters in Springville, Ala., began having concerning cardiac symptoms.
“I was passing out briefly, so that gave me my first indication,” said Long, a Norfolk-Southern retiree. He had a pacemaker implanted, was diagnosed with Afib and was prescribed medication to keep clots from forming in his heart.
In November 2015, Long had his first stroke while back in Indiana visiting relatives for the holidays.
“It showed I was having issues with the blood thinner,” Long recalled.
Doctors took him off the medication, which was one of the newer non-warfarin blood thinners. Then, just before the Longs were planning to leave for Alabama in September, he had his second stroke that caused bleeding in his brain.
A NEW OPTION
At the time, Parkview Heart Institute was preparing to begin implanting the Watchman, made by Boston Scientific, in select patients such as Long for whom long-term blood thinner usage is not an option.
Dr. Bradley Hardin, one of three Parkview cardiology Watchman-trained specialists, put the quarter-size device into Long’s heart on Dec. 8. Long was the third Parkview patient to get the Watchman.
The hour-long procedure involves inserting the inverted umbrella-shaped device into the heart via a catheter threaded into the femoral vein. Patients normally have a 24-hour hospital stay. The membranous device is made of polyethylene plastic and a metal alloy called Nitinol, which has flexibility and shape memory.
“The membrane generates its own clot, and the body covers it with cells,” said Robertson. It takes about 45 days, sometimes a little longer, for the device to adhere to the left atrial appendage opening and to form a barrier to clot pieces moving into the left atrium.
To help ensure no clots dislodge during the procedure and that the device has time to form a tight seal, the Food & Drug Administration (FDA) requires patients be on a blood thinner prior to and for a period following the implant.
MORE FREEDOM FOR PATIENTS
Robertson said the Watchman is giving select Afib patients freedom to have a more active lifestyle without fear of a bleeding injury and reduces the emotional toll that comes from lifelong use of blood thinners. Additionally, the Watchman reduces delays for other medical procedures such as a colonoscopy or knee replacement.
People on blood thinners are required to discontinue them for a time before and after surgery, creating a period of increased vulnerability to stroke. For those on warfarin, blood tests must be done at least monthly. Newer non-warfarin blood thinners require less frequent testing but are considerably more costly than warfarin.
The Watchman, now covered by Medicare and a growing number of private insurers at approved centers, is costly, but Robertson maintains costs even out when emergency and hospital care due to internal bleeding and stroke is compared to the one-time implant.
One study, published in the Journal of the American College of Cardiology in December 2015, looked at prospective cost and effectiveness of the Watchman over 20 years among Medicare beneficiaries. At the 10-year mark, the Watchman became more effective and less costly than warfarin; at the five-year mark, the Watchman became more effective and less costly than newer non-warfarin anticoagulants.
Despite his two strokes, Long is doing well these days, and the couple is back enjoying Alabama sunshine until May, when they’ll return to Hamilton Lake. He is grateful the Watchman became available to him at just the right time and said of his future, “We’ll stay here on this ride for as long as I can.”
Jennifer L. Boen is a freelance writer in Fort Wayne who writes frequently about health and medicine. This column is the personal opinion of the writer and does not necessarily reflect the views or opinion of The News-Sentinel.