For patients with atrial fibrillation, they face increased risk of developing a stroke. When the top chambers of the heart (atria) are not contracting normally, blood clots can form. Sometimes, these blood clots can break away and travel to other parts of the body. When these clots end up blocking a blood vessel in the brain, the person can end up with a stroke. Factors that increases an individual’s risks of developing a stroke include age (older than 65 years for females, 75 years for males), gender (females fare worse than males), high blood pressure, diabetes, prior stroke or TIA, vascular disease (coronary artery disease, claudication) and heart muscle weakness.
To prevent a stroke in patients with atrial fibrillation, blood thinners are typically prescribed. Traditionally, warfarin was the only blood thinner available. Nowadays, several newer blood thinners are available, collective known as NOACs (novel oral anti-coagulants). These include dabigatran (Pradaxa™), rivaroxaban (Xarelto™) and apixaban (Eliquis™).
However, in some individuals, taking blood thinners may result in complications such as bleeding – either from the brain, gut, bladder, chest or skin. Bleeding and other side effects or drug intolerances may force the individual to seek alternatives to blood thinners. Fortunately, there is an alternative, in the form of a device(s) to occlude the left atrial appendage.
The left atrial appendage (LAA) is a long redundant structure (like a windsock, or chickening) situated in the top left chamber of the heart. In adults the LAA has no useful function. However, it can be a major source of blood clots in patients with atrial fibrillation. It follows logically, that closing this appendage to regular flow of blood may reduce the risk of blood clots forming, and travelling elsewhere (embossing).
Devices that are used to close the LAA include the Watchman device, and the Amplatzer Cardiac Plug. Dr. Szto is credentialed to implant the Watchman device at Peninsula Private Hospital. The keyhole procedure is performed under general anaesthetic, and takes approximately 1 hour. Access is via the right groin vein. Barring any major complications, the patient stays overnight in hospital and is discharged the next day. A preliminary separate test called transoesophageal echo (TOE) or CT of the left atrial appendage is performed to make sure that the dimensions of the LAA is suitable for the Watchman device. This device has been approved by the US FDA for use as an alternative to blood thinners.
From 1 Nov 2017, the Watchman device is approved for Medicare Reimbursement in Australia in private hospitals. Dr. Szto has the most experience with insertion of the Watchman device in Victoria,
If you are interested in exploring this alternative further, please contact Dr. Szto’s office on 9789 0088.
Here is a video about the Watchman device insertion: