Device Offers Alternative to Blood Thinner for Stroke Prevention in People with AFib
Drs. Patrick Whalen and David Zhao are among the first in the state to offer new procedure.
It’s no bigger than a quarter, but it can reduce the risk of stroke by 77 percent in people with atrial fibrillation, or AFib, the most common form of irregular heartbeat.
The technology is a left atrial appendage (LAA) closure device called the Watchman that is implanted in a section of the heart. In use in this country for less than a year, the device already has gained acceptance as an effective alternative to blood thinners such as warfarin as a long-term stroke-prevention therapy in people with AFib, especially older adults.
“I think the Watchman is vital,” says Patrick Whalen, MD, Wake Forest Baptist Health’s director of cardiac electrophysiology. Wake Forest Baptist is one of about 75 hospitals in the country to offer the minimally invasive implant procedure. “It could have significant impact on elderly patients, who are at the highest risk for bleeding [and other] consequences of blood thinners."
About Atrial Fibrillation (AFib)
AFib occurs when the heart’s upper chambers—the atria—beat irregularly and too rapidly. Although generally not life-threatening in itself, AFib does have some serious complications, among them the formation of blood clots in the heart that can circulate through the body and block the flow of blood to other organs. A stroke occurs when blood flow to the brain is interrupted.
It is estimated that AFib affects as many as 6 million adults in the United States, is the cause of 750,000 hospitalizations each year and contributes to an estimated 130,000 deaths annually. Those numbers have increased sharply over the past 20 years and are expected to keep going up because Americans are living longer (the incidence of AFib increases with age) and chronic conditions such as obesity and hypertension that can contribute to irregular heartbeat are also on the rise.
According to the federal Centers for Disease Control and Prevention, the stroke risk for people with AFib is four to five times greater than for those who don’t have the condition, and strokes caused by complications from AFib tend to be more severe than strokes with other underlying causes.
Blood Thinners vs. the Watchman Device to Treat AFib
Blood thinners are the most commonly employed long-term stroke-prevention therapy for people with the most common form of AFib, and the most commonly prescribed blood thinner is warfarin (usually dispensed under trade name Coumadin). But warfarin has a number of drawbacks, including increased risk of serious bleeding, the need for regular monitoring, some dietary restrictions and negative interaction with numerous prescription and over-the-counter medicines. Plus, some people simply can’t tolerate blood thinners.
Rather than thinning the blood to prevent clots from forming, the Watchman closes off the LAA, a small pouch in the upper left chamber of the heart. Research indicates that about 20 percent of all ischemic (clot-related) strokes happen in people with AFib and that 90 percent of these can be traced to clots originating in the LAA.
“This means we now have an alternative to blood thinners for patients to help them avoid a stroke,” says David Zhao, MD, chief of cardiology at Wake Forest Baptist and director of the Heart and Vascular Center.
How the Watchman Device Works
In a procedure that takes about an hour, the Watchman device is inserted into the heart via a catheter placed in a vein in the upper leg. Once in place, the wire and mesh device opens like an umbrella to block the LAA. Patients typically spend one night in the hospital, and most are able to stop taking a blood thinner within 45 days, the time it takes for heart tissue to grow over the implant and create a permanent barrier to clot formation.
At Wake Forest Baptist, Whalen and Zhao have implanted several of the devices to date, with excellent results.
Jack Wood of Martinsville, Va., had a Watchman implanted by Whalen in early January.
“I don’t like having to be on blood thinners,” says Wood, who was first diagnosed with AFib about seven years ago. “I’m 80 years old, and if I can get another 10 years, I’d be pretty happy. And I’d like to have a good quality life in those 10 years.
That’s exactly what the Watchman is designed to do for people such as Wood.
“When I talk to patients about AFib, we talk about improving their quality of life and their quantity of life,” Whalen says. “We want patients living longer. One important way to improve longevity is by stroke prevention."
Wood talks more about his experience with the Watchman device in this video by WXII 12 News.
About the Watchman Device
Manufactured by Boston Scientific Corp., the Watchman was approved by the federal Food and Drug Administration in March 2015. Available internationally since 2009, it has been used to treat more than 15,000 patients in over 50 countries.
In early February, the Center for Medicare and Medicaid Services announced that Medicare would cover the cost of the Watchman device and the procedure to implant it in patients who meet certain criteria.