Keeping your heart on beat. AFib treatment options.headingContent

Posted on April 08, 2019

ekg showing heart rhythm

Blood clot formation in the heart or atrial fibrillation (AFib) and the structural heart disease treatment options available today.

The fifth leading cause of death in the United States is stroke. One of the most common causes of stroke is the migration of a small clot from the heart to the arteries of the brain. This cuts off the blood and oxygen supply to that area of the brain and leads to a stroke. One of the most common causes of clot formation in the heart is atrial fibrillation or AFib.

Not only does the heart have a “plumbing system” for pumping blood, but it also has an “electrical system” that is responsible for making sure that the contractions of the heart are synchronized. In individuals with AFIb, the electrical activity in the top chambers of the heart – called atria – goes haywire with rapid random electrical firings. The synchronous unison contraction of the atria is now replaced by quivering and ineffective contractions. This is particularly problematic in an area of the atria called the left atrial appendage (LAA), which is a small pocket protruding from the left atrium. The LAA is heavily trabeculated, or full of small crevices, where blood can stagnate and form a clot. These clots are thought to be the source of stroke in patients with AFib.

Blood thinners, like warfarin, are the mainstay therapy for stroke prevention and treatment in those with AFib. But they carry a risk of bleeding (ex. gastrointestinal bleed, brain bleed), so they are either discontinued in patients with bleeding problems or not even started in those at a high risk of bleeding (ex. frequent falls, high-risk occupations). Not being on blood thinners exposes these patients to the risks of suffering a stroke.

A relatively new device for stroke prevention in patients with AFib was approved by the FDA, it is called the Watchman™. Watchman™ is a small plug that is delivered from the legs into the heart by cardiac specialists. The aim of the plug is to close off the left atrial appendage, the source of clot formation in AFib. Over a period of 1-2 months, heart tissue grows over the plug and forms a barrier to clot formation. Multiple studies have shown that the procedure is safe and that the Watchman™ device reduces the risk of stroke similar to warfarin.

Approximately 3-6 million Americans have AFib and with 25 percent of the population expected to develop AFib in their lifetime, that number is expected to grow dramatically. As such, the burden of stroke is expected to rise as well. Prevention is the best approach to stroke treatment in AFib, and both anticoagulation and the Watchman™ device help achieve that goal. Discuss your options with a cardiac specialist.