Atrial fibrillation is the most common cardiac arrhythmia worldwide. It is widely regarded as an important cause of embolic stroke, that is brain infarction (damage) resulting from thrombotic (clots) s howering the bloodstream as they break off from the heart. The state of ineffective atrial contractions (the two upper chambers of the Heart known as “atria” do not squeeze well) l ead to stasis, and the formations of clot within the heart is a well known consequence. The clot very often occurs in an outpouching of the left atrium, c alled the left atria appendage. The clot has a tendency to be unstable and can fragment allowing s mall particulate matter to sprinkle the blood stream and get transferred t o the brain where a stroke takes place.
A stroke is usually a d evastating event in someone’s life leading to loss of function (eg speech, m ovement etc) or death. P revention of this disastrous complication is by systemic anticoagulation (“Thinning the blood”). The mainstay has always been warfarin for m ost patients, although newer alternatives are available (eg pradaxa, X arelto, eliquis etc). The main issue with “blood thinners” is that th ey can provoke or worsen bleeding — gastrointestinal being a common source of acute or subacute hemorrhage.
Thus, for the past several years, an intracardiac plug known as the “Watchman” has been developed and refined to ex clude or seal the the left atrial appendage [1,2.] According to the em erging literature, it appears to be “as good” as warfarin for st roke prevention due to AFib. It must be noted that most patients r eceive some anticoagulation during the perioperative period while the device endothelializes (“scars into place”). The optimal candidacy of this device is still being defined, however patients who are unable to tolerate warfarin may be considered.
While the Watchman is exciting technology, the post-marketing data (information regarding outcomes, complications etc) will be critical in predicting it’s long-term use.
- http://www.bostonscientific.com/en-US/products/laac-system/watchman-device.html
- F reeman JV, H utton DW et al. CostEffectiveness of Percutaneous Closure of the Left Atrial Appendage in Atrial Fibrillation Based on Results From PROTECT AF Versus PREVAIL. C irc Arrhythm Electrophysiol. 2016?9(6)