Patients who are taking warfarin on a long-term basis have a different option to help prevent blood clots and possible stroke. The Watchman™ Left Atrial Appendage Closure (LAAC) Implant is an alternative for many patients that is designed to work as a safety net by closing off the left atrial appendage (LAA), and catching harmful blood clots before they enter the bloodstream whenever blood pools in the heart.
Joining the show to discuss the Watchman™ Left Atrial Appendage Closure Procedure at Manatee Memorial Hospital is Daniel Friedman, MD, FACC, FHRS. He is a Cardiologist and Watchman Medical Director of the Structural Heart Clinic at Manatee Memorial Hospital.
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Watchman™ Left Atrial Appendage Closure Procedure at Manatee Memorial Hospital
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Learn more about Daniel Friedman, MD
Daniel Friedman, MD
Daniel Friedman, MD is a Cardiologist and Watchman Medical Director, Structural Heart Clinic at Manatee Memorial Hospital.Learn more about Daniel Friedman, MD
Transcription:
Watchman™ Left Atrial Appendage Closure Procedure at Manatee Memorial Hospital
Melanie Cole (Host): Patients who are taking Warfarin on a long-term basis, now have a different option to help prevent blood clots and possible stroke. My guest today, is Dr. Daniel Friedman. He’s a Cardiologist, Electrophysiologist, and Watchman Medical Director of the Structural Heart Clinic at Manatee Memorial Hospital. Welcome to the show, Dr. Friedman. Explain a little bit about the risk for stroke and A-fib and how is that related?
Dr. Daniel Friedman (Guest): Thank you, for having me. The risk of stroke with atrial fibrillation is significant. It increases the risk for stroke about five-times as if you were in normal rhythm. Atrial fibrillation, for those who do not know, is when the top chambers of the heartbeat in a fast and almost chaotic rhythm. This predisposes a blood clot to form, which can then travel through the heart and up to the brain, and so it increases the stroke risk dramatically.
Melanie: So, what’s been the typical treatment for preventing clots if someone is at risk of stroke from A-fib?
Dr. Friedman: The typical treatment for prevention of stroke with atrial fibrillation is a blood thinner. For decades, that’s been Warfarin – or Coumadin is another name for the same medication. The problem with Warfarin or Coumadin is that we thin the entire body’s blood pool, and that can cause bleeding in areas outside of the heart where obviously, that is not desirable. That’s why we have come up with other strategies. These days, there are alternative blood thinners as well – to Coumadin or Warfarin – which are better, but thankfully, at Manatee, we have an even better option.
Melanie: Tell us about this better option – the Watchman Device. Tell us what that is and why somebody might choose it overtaking Warfarin or another blood thinner?
Dr. Friedman: A Watchman Device is a small metal device with fabric on top of it, about the size of a quarter, that gets put into the heart with a catheter in the area of the heart where the blood clots form that cause stroke with atrial fibrillation. This is a good alternative to taking long-term blood thinners, such as Coumadin or Warfarin because it doesn’t cause bleeding. It’s a local, mechanical device that can block any blood clots from escaping the heart and causing a stroke.
Melanie: So, who is a good candidate for this?
Dr. Friedman: Currently, the indications and the candidate for a Watchman Implant would be someone who has atrial fibrillation, who is at increased risk for stroke with their atrial fibrillation, and cannot take or cannot tolerate long-term blood thinners, such as Coumadin or Warfarin. The reason they may not be able to tolerate long-term Warfarin typically is bleeding episodes.
Melanie: Does it reduce the risk of stroke as well as Warfarin? Do we know? Are there any studies on this?
Dr. Friedman: Good question. There have been multiple, large, randomized controlled clinical trials – or studies on Watchman versus Warfarin, and this has shown that the Watchman is as good at preventing stroke. But more importantly, with the latest data that has come out, it has shown that the Watchman actually has a mortality benefit – so, fewer people with Watchman died as compared to patients that were taking Warfarin – and the major strokes – disabling strokes were also less with the Watchman versus the Coumadin or Warfarin patient.
Melanie: Tell us what this procedure is like, Dr. Friedman. Is this considered minimally-invasive? Tell the listeners what it would be like to have the Watchman Device implanted.
Dr. Friedman: Very good question. It is a minimally-invasive catheter procedure, so typically, the procedure is done under general anesthesia and takes about an hour to do. After anesthesia, a small catheter goes through the vein in the right groin area, up into the heart – the left, upper chamber of the heart. Then, like a reverse umbrella, we open up a Watchman Device inside the left atrial appendage, which is a small pouch that hangs off the front, left, the upper chamber of the heart.
Then we take a picture of it with X-ray as well as with echocardiogram, make sure that that area is sealed off, and then we basically release it into the left atrial appendage, where it just stays there and blocks clots for the rest of the patient's’ life. The typical hospital stay after a Watchman Implant is one night, and there’s – it’s not open-heart surgery, it’s a catheter procedure, so the recovery is pretty fast.
Melanie: So, what’s life like after the procedure for the patient? How soon can they get back to normal activity, and do they still have to be on their blood thinners for a certain amount of time post-procedure? And then, what about after that period of time?
Dr. Friedman: Good question. Typically, I recommend the patient not do anything strenuous for approximately a week after the procedure just to prevent bleeding in the access sight in the right groin area. The patient does have to take either Coumadin or another blood thinner for approximately six-weeks after the implant during which time the body is healing over the device itself. And then, another echocardiogram is performed about six-weeks after the implant to confirm that the area is sealed off, and at that point, we stop the blood thinners except for Aspirin. The patient is usually very happy at that point because they don’t have to take their blood thinners at home.
Melanie: And once they can get back to normal activity, is there anything you would like them to know or be concerned with – lifestyle, behaviors, things they should watch out for?
Dr. Friedman: Well, there’s obviously less restriction in terms of diet or activities because you’re not taking a long-term blood thinner anymore, but you can still have atrial fibrillation. It’s important to remember that the Watchman Device doesn’t actually treat the atrial fibrillation but prevents the most concerning consequence of atrial fibrillation. You still need to follow up with your cardiologist or electrophysiologist and treat the atrial fibrillation if you’re still having symptoms, such as congestive heart failure, or rapid rates, or palpitations. Your cardiologist or electrophysiologist can treat your atrial fibrillation still with our usual treatments for atrial fibrillation, such as medications or catheter ablations.
Melanie: Tell us about your team, Dr. Friedman, at the Structural Heart Clinic at Manatee Memorial Hospital. What can patients expect from you guys there?
Dr. Friedman: At Manatee Memorial Hospital, we have a dedicated Structural Heart Clinic in the medical building just across the street from the hospital where we have a dedicated nurse navigator as well as a Nurse Practitioner. They’re very good at following up with the patients on a regular basis as well as obtaining any insurance approval that may be needed and generally keeps the program rolling. Every Monday, I go to the office there and see potential Watchman patients as well as follow up Watchman patients. We’re doing this in a systematic fashion, and that’s really helped to standardized care as well as increase patient satisfaction.
Melanie: And just in summary, Dr. Friedman, tell the listeners what you’d like them to know about what the future holds for stroke reduction in atrial fibrillation patients and what you’d like them to know about the Watchman Device.
Dr. Friedman: I would like patients to know that they’re not going to necessarily be on a blood thinner the rest of their life, that we have come to the point where we’re having good device therapies that can take the place of taking long-term blood thinners. The Watchman is just the beginning of those devices, and I think we’re going to see more and more devices comes out that may even be better in terms of implanting them in all sorts of different anatomies and having not to take the blood thinner even for a short-term after the implant.
I think that the indications for implanting the device in the left atrial appendage to prevent stroke are going to become more lenient as time goes on, and we’ll be able to use this therapy as a first-line instead of as a second-line as it currently is. We’ll have less bleeding events in the future for our atrial fibrillation patients.
Melanie: Thank you so much, for being with us today. You’re listening to Manatee Talk Radio with Manatee Memorial Hospital. For more information, you can go to ManateeMemorial.com, that’s ManateeMemorial.com. Physicians are independent practitioners who are not employees or agents of Manatee Memorial Hospital. The hospital shall not be liable for actions or treatments provided by physicians. Individual results may vary. There are risks associated with any surgical procedure. Speak with your physician about these risks to find out if minimally invasive surgery is right for you. This is Melanie Cole. Thanks so much, for listening.
Watchman™ Left Atrial Appendage Closure Procedure at Manatee Memorial Hospital
Melanie Cole (Host): Patients who are taking Warfarin on a long-term basis, now have a different option to help prevent blood clots and possible stroke. My guest today, is Dr. Daniel Friedman. He’s a Cardiologist, Electrophysiologist, and Watchman Medical Director of the Structural Heart Clinic at Manatee Memorial Hospital. Welcome to the show, Dr. Friedman. Explain a little bit about the risk for stroke and A-fib and how is that related?
Dr. Daniel Friedman (Guest): Thank you, for having me. The risk of stroke with atrial fibrillation is significant. It increases the risk for stroke about five-times as if you were in normal rhythm. Atrial fibrillation, for those who do not know, is when the top chambers of the heartbeat in a fast and almost chaotic rhythm. This predisposes a blood clot to form, which can then travel through the heart and up to the brain, and so it increases the stroke risk dramatically.
Melanie: So, what’s been the typical treatment for preventing clots if someone is at risk of stroke from A-fib?
Dr. Friedman: The typical treatment for prevention of stroke with atrial fibrillation is a blood thinner. For decades, that’s been Warfarin – or Coumadin is another name for the same medication. The problem with Warfarin or Coumadin is that we thin the entire body’s blood pool, and that can cause bleeding in areas outside of the heart where obviously, that is not desirable. That’s why we have come up with other strategies. These days, there are alternative blood thinners as well – to Coumadin or Warfarin – which are better, but thankfully, at Manatee, we have an even better option.
Melanie: Tell us about this better option – the Watchman Device. Tell us what that is and why somebody might choose it overtaking Warfarin or another blood thinner?
Dr. Friedman: A Watchman Device is a small metal device with fabric on top of it, about the size of a quarter, that gets put into the heart with a catheter in the area of the heart where the blood clots form that cause stroke with atrial fibrillation. This is a good alternative to taking long-term blood thinners, such as Coumadin or Warfarin because it doesn’t cause bleeding. It’s a local, mechanical device that can block any blood clots from escaping the heart and causing a stroke.
Melanie: So, who is a good candidate for this?
Dr. Friedman: Currently, the indications and the candidate for a Watchman Implant would be someone who has atrial fibrillation, who is at increased risk for stroke with their atrial fibrillation, and cannot take or cannot tolerate long-term blood thinners, such as Coumadin or Warfarin. The reason they may not be able to tolerate long-term Warfarin typically is bleeding episodes.
Melanie: Does it reduce the risk of stroke as well as Warfarin? Do we know? Are there any studies on this?
Dr. Friedman: Good question. There have been multiple, large, randomized controlled clinical trials – or studies on Watchman versus Warfarin, and this has shown that the Watchman is as good at preventing stroke. But more importantly, with the latest data that has come out, it has shown that the Watchman actually has a mortality benefit – so, fewer people with Watchman died as compared to patients that were taking Warfarin – and the major strokes – disabling strokes were also less with the Watchman versus the Coumadin or Warfarin patient.
Melanie: Tell us what this procedure is like, Dr. Friedman. Is this considered minimally-invasive? Tell the listeners what it would be like to have the Watchman Device implanted.
Dr. Friedman: Very good question. It is a minimally-invasive catheter procedure, so typically, the procedure is done under general anesthesia and takes about an hour to do. After anesthesia, a small catheter goes through the vein in the right groin area, up into the heart – the left, upper chamber of the heart. Then, like a reverse umbrella, we open up a Watchman Device inside the left atrial appendage, which is a small pouch that hangs off the front, left, the upper chamber of the heart.
Then we take a picture of it with X-ray as well as with echocardiogram, make sure that that area is sealed off, and then we basically release it into the left atrial appendage, where it just stays there and blocks clots for the rest of the patient's’ life. The typical hospital stay after a Watchman Implant is one night, and there’s – it’s not open-heart surgery, it’s a catheter procedure, so the recovery is pretty fast.
Melanie: So, what’s life like after the procedure for the patient? How soon can they get back to normal activity, and do they still have to be on their blood thinners for a certain amount of time post-procedure? And then, what about after that period of time?
Dr. Friedman: Good question. Typically, I recommend the patient not do anything strenuous for approximately a week after the procedure just to prevent bleeding in the access sight in the right groin area. The patient does have to take either Coumadin or another blood thinner for approximately six-weeks after the implant during which time the body is healing over the device itself. And then, another echocardiogram is performed about six-weeks after the implant to confirm that the area is sealed off, and at that point, we stop the blood thinners except for Aspirin. The patient is usually very happy at that point because they don’t have to take their blood thinners at home.
Melanie: And once they can get back to normal activity, is there anything you would like them to know or be concerned with – lifestyle, behaviors, things they should watch out for?
Dr. Friedman: Well, there’s obviously less restriction in terms of diet or activities because you’re not taking a long-term blood thinner anymore, but you can still have atrial fibrillation. It’s important to remember that the Watchman Device doesn’t actually treat the atrial fibrillation but prevents the most concerning consequence of atrial fibrillation. You still need to follow up with your cardiologist or electrophysiologist and treat the atrial fibrillation if you’re still having symptoms, such as congestive heart failure, or rapid rates, or palpitations. Your cardiologist or electrophysiologist can treat your atrial fibrillation still with our usual treatments for atrial fibrillation, such as medications or catheter ablations.
Melanie: Tell us about your team, Dr. Friedman, at the Structural Heart Clinic at Manatee Memorial Hospital. What can patients expect from you guys there?
Dr. Friedman: At Manatee Memorial Hospital, we have a dedicated Structural Heart Clinic in the medical building just across the street from the hospital where we have a dedicated nurse navigator as well as a Nurse Practitioner. They’re very good at following up with the patients on a regular basis as well as obtaining any insurance approval that may be needed and generally keeps the program rolling. Every Monday, I go to the office there and see potential Watchman patients as well as follow up Watchman patients. We’re doing this in a systematic fashion, and that’s really helped to standardized care as well as increase patient satisfaction.
Melanie: And just in summary, Dr. Friedman, tell the listeners what you’d like them to know about what the future holds for stroke reduction in atrial fibrillation patients and what you’d like them to know about the Watchman Device.
Dr. Friedman: I would like patients to know that they’re not going to necessarily be on a blood thinner the rest of their life, that we have come to the point where we’re having good device therapies that can take the place of taking long-term blood thinners. The Watchman is just the beginning of those devices, and I think we’re going to see more and more devices comes out that may even be better in terms of implanting them in all sorts of different anatomies and having not to take the blood thinner even for a short-term after the implant.
I think that the indications for implanting the device in the left atrial appendage to prevent stroke are going to become more lenient as time goes on, and we’ll be able to use this therapy as a first-line instead of as a second-line as it currently is. We’ll have less bleeding events in the future for our atrial fibrillation patients.
Melanie: Thank you so much, for being with us today. You’re listening to Manatee Talk Radio with Manatee Memorial Hospital. For more information, you can go to ManateeMemorial.com, that’s ManateeMemorial.com. Physicians are independent practitioners who are not employees or agents of Manatee Memorial Hospital. The hospital shall not be liable for actions or treatments provided by physicians. Individual results may vary. There are risks associated with any surgical procedure. Speak with your physician about these risks to find out if minimally invasive surgery is right for you. This is Melanie Cole. Thanks so much, for listening.