Innovative Procedure for Patients with Atrial Fibrillation Available at Riverside
Dr. Abhimanyu Beri discusses Watchman and how it can benefit patients with atrial fibrillation.
Featured Speaker:
Abhimanyu Beri, MD
Dr. Abhimanyu Beri is board certified in internal medicine, cardiology and cardiac electrophysiology and has authored 19 peer-reviewed medical publications. He is a member of the Heart Rhythm Society. Dr. Beri received his Doctor of Medicine from the Maulana Azad Medical College in New Delhi, India. He went on to complete a residency in internal medicine from Michigan State University followed by a fellowship in cardiovascular medicine at Loma Linda University and a fellowship in clinical cardiac electrophysiology at Kaiser Permanente, both in California. Dr. Beri specializes in atrial fibrillation ablation as well as performing catheter ablation without any X-ray use. Transcription:
Innovative Procedure for Patients with Atrial Fibrillation Available at Riverside
Alyssa Diaz (Host): Hello listeners and welcome to the Well Within Reach podcast. I'm your host Alyssa Diaz, and we’re welcoming back to the studio Dr. Abhimanyu Beri, a clinical cardiac electrophysiologist at the Riverside Heart and Vascular Institute to talk about an innovative procedure for patients with atrial fibrillation that’s available at Riverside. Dr. Beri, thanks for joining the podcast today.
Abhimanyu Beri, MD (Guest): Thank you for having me.
Host: Just let’s do a quick introduction in case listeners haven’t heard your background and talk to us a little bit about your role as an electrophysiologist and your training.
Dr. Beri: An electrophysiologist is a doctor of the heart electrical system alternatively known as a heart rhythm specialist. It is specialized training in diagnosing and treating conditions which can cause the heart’s electrical system to go out of order.
Host: As an electrophysiologist at the Riverside Heart and Vascular Institute, you see patients in a clinical setting as well as a procedural setting. Is that correct?
Dr. Beri: Yes. We do take care of patients, in the hospital, as well as we perform procedures on patients to help treat their heart rhythm disorders.
Host: Today we will be diving into an exciting new procedure that you perform at Riverside for patients with a condition called atrial fibrillation. Now this is a one-time procedure, and it’s really a life changing alternative. It’s a potential for a permanent implant called the Watchman device, and it can provide patients who are living with atrial fibrillation a more permanent solution or treatment. Dr. Beri, tell us about the Watchman.
Dr. Beri: Yes. So the Watchman is a very exciting innovation in this field of electrophysiology. The biggest problem that we face with patients with atrial fibrillation is the elevated risk of stroke. Traditionally the treatment to treat and lower the risk of atrial fibrillation related stroke was Warfarin or Coumarin, which is a rather cumbersome therapy requiring you to have frequent blood tests. A few years ago new medications came onto the market which are still blood thinners, but don’t require blood level monitoring. So you don’t need the frequent blood tests. Over the last five or six years, we have now come to the conclusion that the risk of stroke can be safely and significantly lowered by this procedure called Watchman. There is an appendage in the heart which for those who are familiar not with the heart but with the rest of the body, it’s like the appendix in your belly. You probably know someone who’s had appendicitis which got inflamed and then they had to take the person’s appendix out. Just like that, there is an appendage in the heart. Most clots that happen with atrial fibrillation that can lead to a stroke form in this appendage. The Watchman procedure is a device shaped a little bit like an umbrella which is performed from the leg, and it is used to plug that appendage. As a result, we can safely reduce the risk of stroke in a patient who has atrial fibrillation without them needing to take lifelong blood thinners.
Host: So this is a really innovative solution. Of course, this is something that patients need to discuss with their doctors to find the right treatment for them. For patients who are just seeking general information on atrial fibrillation, Dr. Beri and I did record a previous podcast on that condition as well with other alternative treatments. For the purpose of this conversation, let’s dive a little bit deeper into Watchman. You mentioned that the implant starts in the groin. How is the device implanted? What does it do once it’s in place?
Dr. Beri: So the Watchman device does not require the patient to have any stitches or be cut open. We enter the body with an IV line that is placed inside the vein in one of the legs. The patient is completely asleep for this procedure. Usually it takes about 60 to 90 minutes. Once we enter the body, we go inside the heart, we localize this appendage using ultrasound, and we’re able to implant this umbrella shaped device called a Watchman into the appendage, seal it off so that clots from there cannot escape and lead to strokes.
Host: To give listeners kind of a visual description of what this device implant looks like. As Dr. Beri mentioned, it’s like an umbrella and it almost has like a netting around the outside. If I understand correctly, that’s to help the Watchman device really mold to the body.
Dr. Beri: Yes. So everybody’s appendage is shaped differently. The beauty of this device, it is very flexible. So when we implant this, it somewhat molds to the shape of the appendage of someone else’s body. The mesh on top is like the sieve. So what we’re trying to sieve through is clots. The idea being that any clot that forms in that appendage will be caught by this device and will not enter your bloodstream and go to your brain and cause a stroke.
Host: You talked about the use of Warfarin or Coumadin. That’s something that hopefully overtime patients would be able to discontinue the use of, but it’s not necessarily an immediate stop.
Dr. Beri: Yes. So this device is implanted while the patient is on a blood thinner and it is continued for a short period of time after for a few weeks until we can make sure the device is well sealed. After which we are able to discontinue blood thinners in the vast majority of patients.
Host: It’s quite incredible that this one-time procedure has a long-term stroke risk reduction that’s just so important for patients who have been struggling with atrial fibrillation for potentially years.
Dr. Beri: Yes, absolutely. This is a lifechanging procedure for a lot of patients.
Host: More specifically, who can qualify to receive the Watchman.
Dr. Beri: The Watchman device is indicated per the Medicare guidelines and by the FDA for people that can take blood thinners for a short period of time but not long term. So anybody who has struggled with bleeding which is of any significance from blood thinners, anybody who is not able to come to their INR appointments because they have no way to transport themselves, any patient who is not able to maintain a normal INR level, or any other valid reason for not taking blood thinners. For example they’re in a high-risk operation, they work with heavy machines, sharp equipment, and they’re very afraid of getting themselves cut. This is a very appropriate indication for their treatment.
Host: Very good. What are some of the benefits in addition to the reduced risk of stroke that Watchman can provide?
Dr. Beri: The biggest benefit of Watchman is the reduction of stroke, but the beauty of this is we do not have to take blood thinners anymore. Long-term blood thinners are associated with high risks of bleeding. That could be sometimes very dangerous and often fatal. The risk reduction and the bleeding from blood thinners is one of the biggest secondary benefits of this Watchman device implant.
Host: I can imagine for some of your patients it feels quite freeing to not be held under the thumb of all of these risks.
Dr. Beri: It is fascinating you bring this up. The first time we discuss this with a patient who has been on Warfarin for 10/15/20 years, they’re very hesitant. They feel like a cover has been blown. They're missing their weekly or monthly appointments to the Coumadin clinic, but I'm sure they’re not going to miss it for very long once they get used to living a normal life without having to give blood tests very frequently.
Host: Yeah, exactly. That’s fulfilling. That’s why we do what we do. Riverside is the only hospital in the area to offer this innovative procedure. So what does that mean for you and your team and your patients?
Dr. Beri: We at Riverside are very happy to provide state of the art care for all of our patients. We adopt a team approach where there is a heart team. The patients are discussed and evaluated by a group of cardiologists to make sure we can provide the best, safest, and most comprehensive care for all our patients and we continue to strive to do that.
Host: How might individuals learn more about the Watchman or seek care for other cardiovascular conditions?
Dr. Beri: You can always visit the website at watchman.com which is run by the company and provides very appropriate patient care data. Otherwise talk to your doctor. We’re also always available for consultation, and you can reach us online at riversidehealthcare.org or 844-404-HRTS.
Host: Dr. Beri, thank you for joining us on the Well Within Reach podcast. Listeners, again, that phone number is 844-404-HRTS for the Riverside Heart and Vascular Institute. Thanks for joining us on this Well Within Reach podcast.
Innovative Procedure for Patients with Atrial Fibrillation Available at Riverside
Alyssa Diaz (Host): Hello listeners and welcome to the Well Within Reach podcast. I'm your host Alyssa Diaz, and we’re welcoming back to the studio Dr. Abhimanyu Beri, a clinical cardiac electrophysiologist at the Riverside Heart and Vascular Institute to talk about an innovative procedure for patients with atrial fibrillation that’s available at Riverside. Dr. Beri, thanks for joining the podcast today.
Abhimanyu Beri, MD (Guest): Thank you for having me.
Host: Just let’s do a quick introduction in case listeners haven’t heard your background and talk to us a little bit about your role as an electrophysiologist and your training.
Dr. Beri: An electrophysiologist is a doctor of the heart electrical system alternatively known as a heart rhythm specialist. It is specialized training in diagnosing and treating conditions which can cause the heart’s electrical system to go out of order.
Host: As an electrophysiologist at the Riverside Heart and Vascular Institute, you see patients in a clinical setting as well as a procedural setting. Is that correct?
Dr. Beri: Yes. We do take care of patients, in the hospital, as well as we perform procedures on patients to help treat their heart rhythm disorders.
Host: Today we will be diving into an exciting new procedure that you perform at Riverside for patients with a condition called atrial fibrillation. Now this is a one-time procedure, and it’s really a life changing alternative. It’s a potential for a permanent implant called the Watchman device, and it can provide patients who are living with atrial fibrillation a more permanent solution or treatment. Dr. Beri, tell us about the Watchman.
Dr. Beri: Yes. So the Watchman is a very exciting innovation in this field of electrophysiology. The biggest problem that we face with patients with atrial fibrillation is the elevated risk of stroke. Traditionally the treatment to treat and lower the risk of atrial fibrillation related stroke was Warfarin or Coumarin, which is a rather cumbersome therapy requiring you to have frequent blood tests. A few years ago new medications came onto the market which are still blood thinners, but don’t require blood level monitoring. So you don’t need the frequent blood tests. Over the last five or six years, we have now come to the conclusion that the risk of stroke can be safely and significantly lowered by this procedure called Watchman. There is an appendage in the heart which for those who are familiar not with the heart but with the rest of the body, it’s like the appendix in your belly. You probably know someone who’s had appendicitis which got inflamed and then they had to take the person’s appendix out. Just like that, there is an appendage in the heart. Most clots that happen with atrial fibrillation that can lead to a stroke form in this appendage. The Watchman procedure is a device shaped a little bit like an umbrella which is performed from the leg, and it is used to plug that appendage. As a result, we can safely reduce the risk of stroke in a patient who has atrial fibrillation without them needing to take lifelong blood thinners.
Host: So this is a really innovative solution. Of course, this is something that patients need to discuss with their doctors to find the right treatment for them. For patients who are just seeking general information on atrial fibrillation, Dr. Beri and I did record a previous podcast on that condition as well with other alternative treatments. For the purpose of this conversation, let’s dive a little bit deeper into Watchman. You mentioned that the implant starts in the groin. How is the device implanted? What does it do once it’s in place?
Dr. Beri: So the Watchman device does not require the patient to have any stitches or be cut open. We enter the body with an IV line that is placed inside the vein in one of the legs. The patient is completely asleep for this procedure. Usually it takes about 60 to 90 minutes. Once we enter the body, we go inside the heart, we localize this appendage using ultrasound, and we’re able to implant this umbrella shaped device called a Watchman into the appendage, seal it off so that clots from there cannot escape and lead to strokes.
Host: To give listeners kind of a visual description of what this device implant looks like. As Dr. Beri mentioned, it’s like an umbrella and it almost has like a netting around the outside. If I understand correctly, that’s to help the Watchman device really mold to the body.
Dr. Beri: Yes. So everybody’s appendage is shaped differently. The beauty of this device, it is very flexible. So when we implant this, it somewhat molds to the shape of the appendage of someone else’s body. The mesh on top is like the sieve. So what we’re trying to sieve through is clots. The idea being that any clot that forms in that appendage will be caught by this device and will not enter your bloodstream and go to your brain and cause a stroke.
Host: You talked about the use of Warfarin or Coumadin. That’s something that hopefully overtime patients would be able to discontinue the use of, but it’s not necessarily an immediate stop.
Dr. Beri: Yes. So this device is implanted while the patient is on a blood thinner and it is continued for a short period of time after for a few weeks until we can make sure the device is well sealed. After which we are able to discontinue blood thinners in the vast majority of patients.
Host: It’s quite incredible that this one-time procedure has a long-term stroke risk reduction that’s just so important for patients who have been struggling with atrial fibrillation for potentially years.
Dr. Beri: Yes, absolutely. This is a lifechanging procedure for a lot of patients.
Host: More specifically, who can qualify to receive the Watchman.
Dr. Beri: The Watchman device is indicated per the Medicare guidelines and by the FDA for people that can take blood thinners for a short period of time but not long term. So anybody who has struggled with bleeding which is of any significance from blood thinners, anybody who is not able to come to their INR appointments because they have no way to transport themselves, any patient who is not able to maintain a normal INR level, or any other valid reason for not taking blood thinners. For example they’re in a high-risk operation, they work with heavy machines, sharp equipment, and they’re very afraid of getting themselves cut. This is a very appropriate indication for their treatment.
Host: Very good. What are some of the benefits in addition to the reduced risk of stroke that Watchman can provide?
Dr. Beri: The biggest benefit of Watchman is the reduction of stroke, but the beauty of this is we do not have to take blood thinners anymore. Long-term blood thinners are associated with high risks of bleeding. That could be sometimes very dangerous and often fatal. The risk reduction and the bleeding from blood thinners is one of the biggest secondary benefits of this Watchman device implant.
Host: I can imagine for some of your patients it feels quite freeing to not be held under the thumb of all of these risks.
Dr. Beri: It is fascinating you bring this up. The first time we discuss this with a patient who has been on Warfarin for 10/15/20 years, they’re very hesitant. They feel like a cover has been blown. They're missing their weekly or monthly appointments to the Coumadin clinic, but I'm sure they’re not going to miss it for very long once they get used to living a normal life without having to give blood tests very frequently.
Host: Yeah, exactly. That’s fulfilling. That’s why we do what we do. Riverside is the only hospital in the area to offer this innovative procedure. So what does that mean for you and your team and your patients?
Dr. Beri: We at Riverside are very happy to provide state of the art care for all of our patients. We adopt a team approach where there is a heart team. The patients are discussed and evaluated by a group of cardiologists to make sure we can provide the best, safest, and most comprehensive care for all our patients and we continue to strive to do that.
Host: How might individuals learn more about the Watchman or seek care for other cardiovascular conditions?
Dr. Beri: You can always visit the website at watchman.com which is run by the company and provides very appropriate patient care data. Otherwise talk to your doctor. We’re also always available for consultation, and you can reach us online at riversidehealthcare.org or 844-404-HRTS.
Host: Dr. Beri, thank you for joining us on the Well Within Reach podcast. Listeners, again, that phone number is 844-404-HRTS for the Riverside Heart and Vascular Institute. Thanks for joining us on this Well Within Reach podcast.