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St. Clair Health Offers Advanced Heart Care with Watchman Device

By Kevin Brown

Atrial fibrillation, or AFib, is a fairly common but serious heart rhythm condition that can lead to stroke if left untreated. The US Centers for Disease Control (CDC) estimates that as many as 12.1 million people will have AFib in 2030(1).

AFib occurs when the two upper chambers of the heart, or “atria,” do not coordinate with the “ventricles,” the two lower chambers of the heart. Symptoms can include heart palpitations, shortness of breath, dizziness, weakness, and fatigue, among others. Those with AFib have a high risk of stroke due to blood clots forming in the left atrial appendage. These clots can escape the appendage and be carried to the brain, causing a stroke. Medications called blood thinners are commonly used to prevent blood clots in patients with AFib—however, those medications can lead to internal bleeding in some patients.

St. Clair Health is now offering help for those with AFib who cannot tolerate blood thinners. A device called the WatchmanTM is being used by physicians at St. Clair Health to stop blood clots from escaping the atria. “The Watchman is a device meant to plug a specific area in the heart and is designed to protect people from a blood clot that could lead to a stroke,” says Dr. Jeffrey Liu, St. Clair Health’s Director of Electrophysiology.

The Watchman device is made of a special fabric and looks like an umbrella with an internal wire structure. It is placed in the opening of the left atrial appendage to seal off the appendage and prevent blood clots from escaping.

“The appendage is an area of that chamber that just kind of dangles off the front,” Dr. Liu notes. “It's like the appendix of the heart. And, just like the appendix in the abdomen, the left atrial appendage in the heart really doesn't do anything useful except cause problems. So that's why we can place a plug in there,” he notes.

“The procedure is done in our Electrophysiology Lab here at the hospital,” Dr. Liu explains. “Patients are placed under general anesthesia and several large IVs are inserted in the leg. Through these large IVs, we pass equipment up through the blood vessels into the heart, where we place the Watchman in the atria, using sophisticated imaging techniques to make sure it’s placed where it needs to be.”

According to Dr. Liu, patients are required to lie flat on the back for about four hours after the procedure. “We've been keeping people overnight, but we are probably going to be quickly transitioning to sending people home the same day after the bed rest,” he says. “The only recovery restrictions that we place on patients afterwards is that we ask them to take it easy for two weeks. No heavy lifting and no vigorous exercise, only to minimize the risk of bleeding at the leg site.”

“It takes about six weeks for the Watchman device to scar over—what we call endothelialize, or the endothelial tissue grows over the device,” Dr. Liu notes. “During that six-week period, it's very important for patients to maintain a blood thinner because they are actually at a bit of a higher risk of blood clots and stroke in the immediate aftermath of the device placement. The hope is that, after about six weeks if everything is sealed off, then we can try to get the patient off the blood thinner.”

It is important to note that the Watchman does not correct AFib. “The Watchman does not change the burden of the condition,” Dr. Liu explains. “It's strictly meant to potentially protect against a blood clot from causing a stroke,” he advises. And preventing strokes in AFib patients is key to improving long-term survival—especially in patients who cannot tolerate blood thinners.

For more information about AFib and the Watchman device, please visit the St. Clair Health website at www.stclair.org or call (412) 942-4000.

1 www.cdc.gov/heartdisease/atrial_fibrillation

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