Cardiologists at UC Davis are the first in Northern California to treat the major risk of stroke that comes with atrial fibrillation (AF), the most common form of arrhythmia, with a device that blocks blood clots from traveling from the heart to the head.
The flexible, metal-and-mesh shield, known as the Watchman, is placed using a catheter at the opening of the left atrial appendage — a small pouch in the upper chamber where blood can pool and clot when the heart beats out-of-sync.
Because 95 percent of strokes in AF patients are caused by clots that travel from the left atrial appendage to the narrow vessels in the brain, nearly all patients with the condition are first treated with blood thinners. These medications, however, significantly increase the chances of bleeding disorders and require constant patient oversight.
“Treatments for regulating heart-rhythm problems that occur with AF are constantly getting better,” said Jason Rogers, director of interventional cardiology at UC Davis Health System. “At the same time, stroke-prevention options beyond anticoagulants haven’t changed much for patients who can’t tolerate these medications.”
Carol Woody was one of those patients.
“When I was hospitalized for bleeding, my doctor and I knew we had to try something else,” Woody said.
The Manteca, Calif., retiree was first diagnosed with AF seven years ago when she became too tired for even simple, everyday activities.
“The exhaustion was overwhelming,” she said. “There were days when it was really hard to get out of bed.”
While electrical cardioversion, or a low-voltage electric current, helped reset her heart rhythm, she was referred to Rogers, a specialist in catheter-based treatments for heart disease, to address her stroke risk.
Rogers and his team in the UC Davis Structural Heart Disease Clinic thought Woody was a good candidate for the new device, which was evaluated at UC Davis as part of a clinical trial. The study compared the safety and efficacy of the Watchman with a traditional blood-thinning medication and found that those with the implant had fewer bleeding complications and improved survival during five years of follow up. As a result, the device was approved in March of this year by the U.S. Food and Drug Administration for patients with adverse reactions to blood thinners.
About atrial fibrillation
What is atrial fibrillation (AF)?
AF is diagnosed when the heart beats too rapidly, too slowly or too irregularly due to uncoordinated electrical signals between its chambers.
What are the dangers?
AF patients have greatly increased risks of ischemic stroke and heart failure.
What are the symptoms?
The most common are chest pain, fainting, palpitations, dizziness or tiredness, however many people have no symptoms.
How is it treated?
Medications, catheter-based interventions, implanted defibrillators or heart surgery can restore heart rhythm. All patients with AF require special stroke-prevention measures.
For more information:
Visit the National Heart, Lung and Blood Institute website.
During a one-hour procedure on May 6, Rogers implanted the device in Woody’s heart using a small catheter that he threaded through her femoral vein, starting from her groin. He positioned it at the opening of the left atrial appendage where it will permanently stay, trapping clots where they are harmless.
Woody was in the hospital for one night and will see Rogers twice for follow-up exams. While she is still taking blood-clot medications, she will be weaned off of them within six months.
“I can’t wait for my time with blood thinners to be over,” she said.
Rogers is currently following numerous patients who have received the device. The biggest change has been in their quality of life, he said.
“They are ecstatic that there is something that can help prevent strokes, and that they don’t have to live constantly worried about the fear of bleeding problems,” Rogers said.
More information about UC Davis Division of Cardiovascular Medicine is at www.ucdmc.ucdavis.edu/heart.To request a referral, call 1-800-4-UCDAVIS.