A New Preventative Procedure for Stroke
Jun 26, 2018
Patients suffering with an abnormal heart rhythm, known as Atrial Fibrillation (AF), will now have access to a new treatment option to lower the risk of stroke here at St George Private Hospital in Kogarah. The WATCHMAN device is implanted into the patient’s heart without the need for open heart surgery and it is used to prevent harmful blood clots from entering the blood stream and travelling to the brain causing strokes.
Atrial fibrillation (AF) is a major risk factor for heart failure and stroke, increasing the risk of stroke by 6 times. Usually AF is treated with blood thinners (anticoagulants) to minimise the risk of stroke however a proportion of patients who are candidates for anticoagulation are unable to tolerate these due to medical side effects. This group of patients have previously been "untreatable" with a very high risk of potentially disabling stroke.
“Anticoagulation such as Warfarin reduces the risk of stroke but because it significantly thins the blood there can be bleeding problems, especially for the elderly, most often from the bowel or stomach,” said Dr Gomes, the first Cardiologist to perform this procedure at St George Private.
Strokes that are caused by AF most commonly arise because of blood clotting in the left side of the heart, this location is known as the Left Artrial Appendage. The WATCHMEN device is used to close the Left Atrial Appendage and the procedure. This device has the largest amount of scientific data to support its use and has been compared to anticoagulants in clinical trials, shown to be as good as Warfarin.
“The Watchmen procedure is very different to taking long term anticoagulants. For many AF patients anticoagulant medications aren’t an option because of the intolerable side effects. This is a great alternate for patients who are at a high risk of stroke but aren’t on medication” says cardiac electrophysiologist Dr Sean Gomes.
The procedure involves a general anaesthetic and take around 1.5 hours to complete with an overnight stay in hospital. Once asleep a cardiac ultrasound with images obtained via a probe in the oesophagus is performed to exclude a clot in the left atrial appendage.
A flexible tube called a catheter is inserted into a vein in the groin with a needle. The Watchmen device is located inside the catheter at the tip. The catheter is then guided up the vein and inserted through a tiny hole which is made in the connection between the top two chambers of the heart. Measurements are taken of the left atrial appendage of the heart as the device needs to be sized to suit each patient (it comes in 5 sizes). The Watchman device is then released from the catheter under video X-ray and ultrasound monitor guidance. Stability of the device is confirmed then the sheath is removed.
The benefits of this procedure for patients is that they may be protected from stroke when they are unable to take or tolerate anticoagulants.