Alternative to blood thinners available for patients with atrial fibrillation

Atrial fibrillation, or AFib for short, currently affects an estimated five million people in the United States and puts them at five times greater risk of stroke than people without the condition. AFib patients take blood thinners to reduce their risk of a stroke, but the treatment puts them at greater risk of bleeding complications.

"Given that they are not selective for the heart, these drugs increase the risk of bleeding elsewhere," said Dr. Kousik Krishnan, associate professor of medicine and cardiac electrophysiologist at Rush.

WATCHMAN Implant prevents clots from entering bloodstream

The most common cardiac arrhythmia, AFib causes the upper chambers (atrium) of the heart to beat too quickly and with irregular rhythm (fibrillation). Because the heart does not beat properly in atrial fibrillation patients, it may not fully pump blood out of the heart, causing the blood to pool and then clot in the left atrial appendage, a pouch in the heart's left atrium. In some cases, the blood clots can break loose and travel in the bloodstream to the brain, resulting in a stroke.

The new treatment, called a WATCHMAN Implant, is available for patients whose atrial fibrillation is not caused by a heart valve problem (a condition known as non-valvular AFib). The WATCHMAN device is the size of a quarter and is implanted in the left atrial appendage to prevent any blood clots that form there from entering the bloodstream.

By closing off the left atrial appendage, the implant over time may allow a patient to stop taking blood-thinning medications such as warfarin. Past studies have shown that the WATCHMAN device offers these patients as much protection from stroke as blood thinners.

Despite their effectiveness, taking blood thinners for long periods of time can be difficult for patients, because they are not always well-tolerated and they presents a significant risk for bleeding complications. "Blood thinners have been the standard course of treatment, but, for some patients, an alternative such as this device that could free them from the challenges of long-term blood-thinning therapy is a better, long-term approach," Krishnan said.

Device is implanted using minimally invasive procedure

To install the WATCHMAN t a cardiologist threads the device through a tube, or catheter, from a small incision in the groin through the blood vessels to the heart and to the left atrial appendage. Advanced cardiac imaging specialists help guide the hour-long procedure, which is performed with the patient under general anesthesia under the care of cardiac anesthesiologists.

Patients typically are released from the hospital in less than 24 hours after the procedure and gradually decrease their use of blood thinner medication over time (usually 45 days), under supervision of their cardiologist.

More than 750,000 hospitalizations involving atrial fibrillation occur each year, according to the Centers for Disease Control and Prevention. The condition also contributes to an estimated 130,000 deaths annually.

"The incidence of atrial fibrillation rises as people get older, and it is a huge burden on them that increases their risk of stroke," Krishnan said. "This new therapy can lower the risk of stroke and benefit many patients who are not considered optimal candidates for blood thinners."