Device replaces blood-thinners for AFib patients
Barbara Dowell never liked taking blood-thinners.
Sure, the anti-coagulant drug warfarin helped fend off the threat of strokes for the 74-year-old Dowell, who suffers from atrial fibrillation. But doctors had trouble getting the dosage just right, meaning her blood sometimes was too thick and other times so thin that she was susceptible to bleeding.
In late February, the retired office worker from Whitehaven became the first local patient to undergo a new surgical alternative to blood-thinners. Cardiologist Dr. James Litzow implanted a device that closes off blood flow to the left atrial appendage, a small sac in the top left chamber of the heart, the area where stroke-causing clots most commonly form in AFib patients.
So far, more than a half-dozen people in the Memphis area have received the left-atrium-appendage-closure device, with all the procedures performed at Methodist Le Bonheur Germantown Hospital.
Dowell said she’s happy to have gotten the implant, brand-named the Watchman.
“I prayed over it,” she said of the decision. “He (Litzow) put my pacemaker in, so I had confidence in God and in him.”
Litzow, with the Sutherland Cardiology Clinic, described the new procedure as a major advance in protecting AFib patients from strokes.
Blood-thinners present a small but consistent risk of excessive bleeding, which is especially dangerous when it occurs in the brain, spinal cord or intestinal tract. The elderly and others who are weak and susceptible to falling face the highest risk.
“I think it’s very significant,” Litzow said of the new procedure. “The biggest complaint we get from patients on anticoagulants is they’re afraid of bleeding.”
The most common type of heart arrhythmia, AFib is a fluttering or quivering irregular heart beat that afflicts between 2.7 million and 6.1 million Americans, with those over age 65 most likely to have it.
Because the heart isn’t pumping robustly — with the atrium quivering instead of contracting — blood can pool in the left atrial appendage, leading to clots that travel to the brain, causing strokes.
AFib causes an estimated 15-20 percent of all strokes that are triggered when blood flow to the brain is blocked by clots or by fatty deposits in the lining of vessels. The condition contributes to 130,000 deaths annually, according to the federal Centers for Disease Control and Prevention.
Death rates linked to AFib have been rising, according to the CDC, and the condition is expected to become even more common with the aging of the U.S. population.
To implant the Watchman, surgeons insert a small tube into the groin area and guide it through the veins all the way to the heart. After the device reaches the right side of the heart, doctors must puncture the wall separating the left and right upper chambers to get to the left atrium.
“That is one of the most challenging parts of the procedure,” said Dr. Rajesh Kabra, a cardiologist with UT Methodist Physicians who also has implanted the devices.
Once the tube has been guided to the left atrial appendage, the wire-mesh device is opened like an umbrella in front of the entrance to the sac.
Over a period of about 45 days, during which the patient remains on bloodthinners, the heart gradually forms tissue over the device to permanently cut off blood flow to the appendage.
“We plug that pouch, and heart tissue grows,” Kabra said.
Once an echocardiogram confirms that the appendage has been sealed, patients can be taken off blood-thinners, Litzow said.
Reach Tom Charlier at thomas. charlier@commercialappeal.com or 901-529-2572 and on Twitter at @thomasrcharlier.