An alternative to oral anticoagulation for atrial fibrillation

Atrial fibrillation, or aFib, is a common heart rhythm abnormality.

It happens when the two upper chambers of the heart beat irregularly and fast (fibrillate). Patients with aFib may have no symptoms. Others may feel symptoms such as a fluttering sensation in the chest, shortness of breath, chest discomfort or fatigue with exercise. At least 2.7 million Americans are living with aFib.

During aFib, blood isn’t pumped out of the heart normally. For that reason, it’s easier for blood cells to stick together and form clots in an area of the heart called the left atrial appendage (LAA).

In people with aFib not caused by heart valve problems (non-valvular aFib), more than 90 percent of stroke-causing clots that come from the heart are formed in the LAA. When a blood clot escapes from the LAA and travels to the brain, it can cut off the blood supply to the brain and cause a stroke. As a result, an average person with untreated aFib is five times more likely to suffer a stroke than somebody with a normal rhythm.

Blood thinning medications are often prescribed for patients with aFib to prevent and treat blood clots. Oral anticoagulants such as warfarin or Coumadin are often prescribed. Newer anticoagulants such as dabigatran, rivaroxaban, apixaban and edoxaban are also available. Anticoagulants are effective in decreasing the risk of clot and stroke, but they also increase the risk of bleeding.

The Watchman atrial appendage closure implant is a new stroke reduction option and an alternative to long-term oral anticoagulants for certain patients with atrial fibrillation. The device reduces the risk of stroke as effectively as warfarin in patients with non-valvular aFib. It may also reduce the long-term risk of bleeding that comes with anticoagulant use.

The Watchman is implanted by placing a narrow tube in the vein in the upper leg or groin. From there, the device is guided into the LAA of the heart, preventing blood clots from coming out of it. Heart tissue grows over the implant and the LAA is permanently sealed. The procedure is performed under general anesthesia and it lasts for about an hour. The patients typically stay in the hospital overnight and leave the next day.

Patients remain on warfarin and aspirin for at least 45 days after the procedure. If the LAA is adequately sealed, patients stop the warfarin and take plavix and aspirin for the first six months from the procedure. After that, they take aspirin only.

More than 20,000 Watchman procedures have been performed worldwide. The device was approved by the FDA in March 2015 in the U.S. and in Europe in 2005.

The safety of the Watchman procedure has been shown in two clinical trials and three registries in the U.S. and in Europe. A study of real-world implants, which was reported last fall, showed a low rate of complications from the procedure, and the device was implanted successfully in 95 percent of patients.

The Watchman implant procedure has been performed at Wesley since August 2016.

This story was originally published July 9, 2017 at 5:59 PM with the headline "An alternative to oral anticoagulation for atrial fibrillation."