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Treatment for abnormal heart rhythms due to A-Fib
By DuPage Medical Group Cardiology

Atrial fibrillation (also referred to as a-fib or AF) is one of the most common types of abnormal heart rhythms. A-fib affects nearly 6.1 million people in the United States today. 1,2   A-fib is caused by abnormal electrical impulses that are generated from the upper chambers of the heart (atria). It impairs the ability of the atria to pump blood, and usually causes the heart to beat too rapidly.

Approximately a half million new cases of a-fib are diagnosed every year in the U.S., and billions of dollars are spent annually on its diagnosis and treatment including the more than 750,000 hospitalizations that occur each year because of a-fib. A-fib is a serious condition that leads to an estimated 130,000 deaths each year. A rate which has continued to rise over the last two decades.3,4

There are many causes of a-fib.  Factors that contribute to a-fib include:

  • Age
  • Disorders affecting the mitral valve of the heart
  • Genetic predisposition
  • Obesity
  • Consuming alcohol, caffeine or tobacco (these act as stimulants to the heart)
  • Sleep apnea and other lung problems
  • High blood pressure
  • Hyperthyroidism
  • Stress brought on by any severe illness

While it is possible to have a-fib without any symptoms, most patients have symptoms such as:

  • Heart palpitations (a sensation that the heart is racing or fluttering)
  • Feeling faint or lightheaded
  • Shortness of breath
  • Fatigue
  • Chest pain or discomfort

If you are experiencing any of these symptoms, it is important to see your health care provider for further evaluation. Even if you are not experiencing any symptoms, your provider could diagnose a-fib by finding an irregular heartbeat during a physical exam.  

Diagnosing a-fib is important because of the serious health risks associated with the disease, specifically stroke and heart failure.  Patients with a-fib are five times more likely to suffer a stroke than patients with a regular heartbeat. This is because a-fib causes blood to pool in the left atrium of the heart, leading to blood clots that can be pumped to the brain.

Traditionally, treatment for patients with a-fib involved the long-term use of blood thinning medications known as anticoagulants. Anticoagulants prevent blood clots from forming, and significantly lower the risk of stroke.  However, anticoagulants may not be effective or safe in some patients. Anticoagulants can cause an increased risk of bleeding. Thus, patients who are at a higher-risk for bleeding, whether it’s due to a more active lifestyle, fall risk and other factors, may not be candidates for anticoagulation.

The WATCHMAN™ procedure provides patients with an alternative treatment option through a one-time, safe and effective minimally invasive procedure. It is the only FDA-approved implant proven to reduce the risk of stroke for patients with non-valvular atrial fibrillation. The permanent implant works by blocking access to the left atrial appendage (LAA), which is located inside the left atrium of the heart.  More than 90% of stroke-causing blood clots originate in the LAA for individuals with non-valvular a-fib. The WATCHMAN™ implant fits into the LAA and permanently closes it off to keep blood clots from forming. The implant is lightweight and small, and is approximately the size of a quarter.

During the procedure, a cardiologist implants the device by inserting a narrow tube into a vein in the upper leg to gain access to the chest. The cardiologist then guides the WATCHMAN™ implant into place in the LAA. The procedure is done under general anesthesia, and takes about an hour to complete. Most patients return home the next day.

Following the procedure, patients will take warfarin (an anticoagulant) for about 45 days while heart tissue grows over the implant to form a barrier. The cardiologist will closely monitor this progress.  Once the LAA has become completely closed off, the blood thinner medication can be discontinued.

During a clinical trial:

  • 92% of patients were able to stop taking warfarin 45 days after the procedure
  • 99% of patients were able to discontinue warfarin use within a year.

**A very small percentage of patients may need to keep taking blood thinners long-term.

The WATCHMAN™ procedure is a safe and effective way to prevent strokes in patients with a-fib. Currently more than 30,000 WATCHMAN™ procedures have been performed worldwide. As with any medical procedure, there are risks associated with WATCHMAN™.  Your cardiologist will help you determine if WATCHMAN™ is an appropriate treatment option for you.

Always discuss any heart-related questions or concerns with your health care provider. To schedule an appointment with a DMG Cardiologist visit www.dupagemedicalgroup.com/services/cardiology

Cardiologists at DuPage Medical Group have been performing implantation of THE WATCHMAN™ with success since 2015.

 

References

January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC Jr, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation. Journal of the American College of Cardiology. 2014;64(21):2246–80.

Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation. 2015;131:e29–e322

Agency for Healthcare Research and Quality. Weighted national estimates. HCUP National Inpatient Sample [online]. 2012. [cited 2015 Feb 9]. Available from: http://hcupnet.ahrq.gov/HCUPnet.jsp.

Centers for Disease Control and Prevention. About multiple cause of death 1999–2011. CDC WONDER Online Database. 2014. [cited 2014 Oct 2]. Available from: http://wonder.cdc.gov/mcd-icd10.html.

 

 



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