Reducing Stroke Risk for People With Atrial Fibrillation

RashbaEric Rashba, MD
Director, Heart Rhythm Center
Stony Brook University Heart Institute

People with an irregular heartbeat called atrial fibrillation (AFib) have a five-to-seven percent increased risk of having a stroke compared to people without AFib. To help prevent strokes, blood thinners such as direct oral anticoagulants or warfarin are prescribed. Most people do well, but some experience bleeding problems or have other reasons why blood thinners aren’t the best option. Dr. Eric Rashba, Director, Heart Rhythm Center at Stony Brook Heart Institute, explains how a device called WatchmanTM, which is implanted in the heart, can offer a lifelong solution for those dealing with this problem.

What does the Watchman implant do?
Watchman offers protection from strokes for people who have AFib that’s not caused by a heart valve problem. It provides an alternative to the lifelong use of blood thinners (anticoagulants) for people with AFib by blocking blood clots from leaving the heart and possibly causing a stroke.

Why are people with AFib at risk for stroke?
With AFib, the upper chambers of the heart beat in an irregular rhythm. This disrupts how the heart pumps blood, which can result in blood possibly forming clots in a chamber of the heart called the left atrial appendage, or LAA for short. If a clot leaves the LAA, it can block blood flow to the brain and cause a stroke. More than 90 percent of stroke-causing blood clots that arise in the heart come from the LAA.

How does the Watchman implant work?
Because Watchman is officially named a “left atrial appendage closure implant.” In plain English, this means that it is a device that gets implanted into the LAA to block blood clots from leaving the heart. The FDA-approved Watchman device is about the size of a quarter. When it is inserted into the LAA, the device expands like an umbrella so no blood can leak out. Then, over the next 45 days, cardiac tissue grows over the implant to permanently block off the LAA.

How is Watchman implanted?
At Stony Brook, Watchman is implanted by a multidisciplinary team in a minimally invasive, nonsurgical procedure done in the Heart Rhythm Center’s electrophysiology lab. With the patient under general anesthesia, we insert a small catheter carrying the Watchman device into the patient’s upper leg, and thread it up into the LAA. We use real-time echocardiograms and x-rays during the procedure to help ensure proper fit and placement of the device. Implanting Watchman takes less than two hours, and patients are able to leave the hospital after an overnight stay.

Who is Watchman right for?
The Watchman implant is appropriate for people who:
• have AFib not related to heart valve disease
• are at increased risk for a stroke
• are appropriate for short-term, but not long-term treatment with blood thinning medicines such as warfarin (Coumadin)
• are unable to stay within the recommended blood clotting range while taking warfarin
• have an appropriate reason to seek a non-drug alternative to warfarin, such as a history of serious bleeding, a high risk for falling, or jobs or hobbies that increase the risk for bleeding

Why are you so excited about Watchman?
This has been shown to be a truly good alternative to blood thinners for my patients. It’s the first alternative that has been rigorously studied and has a proven record of safety after more than 100,000 procedures performed worldwide. Watchman effectively provides protection equivalent to anticoagulants for preventing strokes and avoiding the risk of serious bleeding. It has saved lives and improved my patients’ quality of life.

For more information, call Stony Brook Heart Institute at (631) 44-HEART (3278).


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