Some call it “palpitations.” Others say it feels like a fluttering in the chest. Atrial fibrillation — an irregular heartbeat — affects millions of Americans. And while these descriptions may make it seem like a minor sensation that’s easy to live with, when the heart beats with an irregular rhythm and blood does not flow as it should, clots can form, leading to a stroke. According to the American Heart Association, approximately 15 to 20 percent of individuals who experience strokes have atrial fibrillation.
Hartford retiree Linda Smith has been living with atrial fibrillation since 2013. Like many patients, she has been taking an anticoagulant to thin her blood and reduce the possibility of developing a clot. Blood-thinning medication has long been the standard treatment for people living with atrial fibrillation. But Linda was having inconsistent results. The blood test she took regularly to monitor the medication’s effectiveness revealed that sometimes her blood took too long to coagulate, which can lead to bleeding. At other times, it coagulated too quickly, which can lead to a clot.
“It was up and down all the time, and I was very uneasy about it,” Linda said. A longtime Froedtert & MCW patient, Linda saw an article in the May 2016 issue of Froedtert Today in which David Marks, MD, interventional cardiologist, discussed the WATCHMAN™ device, a left atrial appendage (LAA) closure device that reduces the risk of stroke in patients with atrial fibrillation, allowing them to discontinue blood-thinning medication. The WATCHMAN device can also reduce long-term bleeding risk and eliminate the regular blood tests and food and drink restrictions common with the blood thinner warfarin.
“I thought this might be the answer to my problem, so I called Dr. Marks’ office for an appointment,” Linda said. “I also read about WATCHMAN online. It seemed pretty reasonable. And as far as the surgery, compared to some I’ve had in the past, it seemed relatively low risk.”
Ensuring a Good Fit
“When Linda came to us pursuing this therapy, the first thing we did was determine if her anatomy and heart were appropriate for WATCHMAN,” Dr. Marks said. Helping make the assessment were Joshua Meskin, MD, cardiologist, and Marcie Berger, MD, electrophysiologist.
To evaluate Linda, Dr. Meskin conducted a transesophageal echocardiogram, in which a thin tube passed down the throat uses sound waves to produce images of the heart and arteries. “The left atrial appendage, where the WATCHMAN device is placed, has to be suitably configured; it has to be long enough and wide enough to accommodate the device,” said Dr. Berger, who, as a specialist in arrhythmias, sees a number of patients seeking an alternative to anticoagulant therapy.
“I’m a former academic,” Linda said. “I started teaching middle school and ended up spending 13 years at the University of Wisconsin-Oshkosh as professor of curriculum and instruction. So I really appreciate academic medicine, and I know that within the Froedtert & MCW health network, patients really benefit from up-to-date, research-based medicine.”
Placing the WATCHMAN Device
Linda’s procedure was done in a catheterization lab under general anesthesia to allow for patient comfort. A catheter that houses the WATCHMAN device is threaded through a vein in the upper leg. Then, the catheter is guided, using a transesophageal echocardiogram, into the heart’s left atrial appendage, and the WATCHMAN device is permanently placed. One night of hospitalization after the procedure is common.
Looking something like a parachute, the WATCHMAN device is made from a light metal and expands once it is positioned. “It covers the mouth of the left atrial appendage, so blood can’t flow in and out,” Dr. Marks said. “In atrial fibrillation, the atria do not contract rhythmically. Blood swirls and stagnates in the left atrial appendage and blood clots form there. The device is as effective as medication at reducing the risk of stroke or embolism.”
A month after her procedure, Linda returned for testing to ensure the device was properly in place and sealing the LAA. Once confirmed, she was taken off her blood-thinning medication. “I feel more confident about this whole issue,” she said. “It has brought me great peace of mind.”