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Atrial fibrillation (A-Fib) is the most common heart rhythm disorder in the United States affecting about 2.7 million people.
In A-Fib, the top chamber of the heart, called the atrium, is beating about 300-400 beats per minute which means that it really is no longer pumping blood and is just quivering. When this happens, slow blood flow in this chamber can cause a clot to form. This clot can break loose, travel to the brain and cause a stroke.
Patients with A-Fib are 5 times more likely to have a stroke than patients without A-Fib. Also, strokes in patients with atrial fibrillation are more likely to be severe or fatal.
For decades, the treatment to prevent strokes was blood thinners. Blood thinners are very effective and reduce the risk of stroke in patients taking them by almost 70%. Warfarin, or coumadin, was the first blood thinner used in prevention of stroke. It is very effective, but it is difficult to take. It requires monthly blood tests and its effectiveness and bleeding risk can change with diet and other medications.
There are newer medications that are easier to take, are less altered by other medications and don’t require monthly blood tests. These medications are Rivaroxaban (Xarelto), Dabigatran (Pradaxa), Apixaban (Eliquis) and edoxaban (Savaysa).
While these blood thinners are very safe and effective, for many people they can cause bleeding. In some cases this bleeding is serious which prevents about one-third of people who need a blood thinner from taking one.
Fortunately, there are alternatives. One of these is the Watchman Device, an FDA-approved, small umbrella (Figure 1) that can be placed in the left atrial appendage (LAA) (Figure 2).
Printed with Permission from Boston Scientific.
The device is inserted into the heart from a tiny tube placed in the leg similar to a heart catheterization. The left atrial appendage is a small sac that is attached to the left atrium. When a patient is in A-Fib and the heart is quivering, the slowest blood flow is in the appendage and most clots form in this location.
The Watchman device can be inserted into the appendage preventing clots from going to the brain and causing a stroke. Patients who receive this device must be on a blood thinner for a short period of time but eventually this drug is stopped. There are rare risks of the procedure and not everyone can have this device.
Some important information about the WATCHMAN procedure: