Treating Afib Patients, Preventing Strokes from Clots at the Cleveland Clinic with The Watchman

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Kelly Bowman reports on a device that’s helping prevent strokes in patients with Atrial Fibrillation at risk of bleeding.

The left atrial appendage (LAA) is a small, ear-shaped sac in the muscle wall of the left atrium (top left chamber of the heart) with an unknown function. The LAA may have no function at all — sort of like a vestigial organ like an appendix of the heart.

In normal hearts, the heart contracts with each heartbeat, and the blood in the left atrium and LAA is squeezed out of the left atrium into the left ventricle (the bottom left chamber of the heart that consequently pumps oxygenated blood to the body and brain).

When a patient has atrial fibrillation, the electrical impulses that control the heartbeat do not travel in an orderly fashion through the heart. Fibrillation in the ventricles or lower chambers causes sudden cardiac arrest and death, but fibrillation of the upper chambers of the heart results in the heart stammering along, but still allowing overall functioning of the body and brain. In atrial fibrillation, many impulses begin at the same time and spread throughout the atria. The fast and chaotic impulses do not give the atria time to contract and/or effectively squeeze blood into the ventricles. Because the LAA is a little pouch, blood collects there and can form clots in the LAA and atria. When blood clots escape the atria and are pumped out of the heart via the left ventricle, they can cause a stroke. People with atrial fibrillation are 5 to 7 times more likely to have a stroke than the general population.

According to the Cleveland Clinic, taking a blood thinner, such as warfarin (Coumadin), reduces the risk of stroke in patients with atrial fibrillation. Many patients have concerns about, or dislike, taking warfarin. Some of the reasons for this are:

Frequent blood draws are needed to measure the patient’s international normal ratio (INR), or clotting time. The tests are needed to make sure the patient takes the right amount of medication.
While taking warfarin, you need to limit your intake of certain foods that contain vitamin K.

The risk of bleeding is higher while taking warfarin.

Some patients do not tolerate warfarin or have trouble maintaining a normal INR.

New Medications
New medications are available for patients with atrial fibrillation who do not have heart valve disease. These medications are dabigatran (Pradaxa) and rivaroxaban (Xarelto). However, like warfarin, some patients have concerns and problems with these medications, such as:

Patients who cannot take anticoagulants can not tolerate these medications.

Some patients are concerned about the cost of the medication.

These medications also increase the risk of bleeding.

The WATCHMAN Device is a parachute-shaped, self-expanding device that closes the LAA, and is designed to prevent clots from becoming an issue with atrial fibrillation. THE WATCHMAN was tested in several studies that showed the device was a good alternative treatment for patients who cannot tolerate treatment with warfarin. THE WATCHMAN has been approved by the FDA.

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