New heart procedure at Memorial reduces stroke risk

January 23rd, 2017

Thanks to a new procedure being offered at UCHealth Memorial Hospital, Charlie Coble is back to enjoying his favorite pastime – swinging a golf club and walking the rolling fairways of golf courses across the nation.

Coble, 76, was among the first patients at the hospital to be implanted with a new cardiac device called the Watchman that not only reduces the risk of strokes for people with atrial fibrillation – an irregular heartbeat – but also can allow those patients to stop taking powerful blood thinners.

Dr. Brad Mikaelian, a cardiac electrophysiologist at Memorial, is the first doctor in southern Colorado to perform the Watchman procedure.
Dr. Brad Mikaelian, a cardiac electrophysiologist at Memorial, is the first doctor in southern Colorado to perform the Watchman procedure.

About 5 million people in the United States have atrial fibrillation, a condition that can cause blood to pool and then clot in an area of the heart called the left atrial appendage. AFib, as it’s commonly known, causes about 20 percent of all strokes, and blood thinners are commonly prescribed to reduce the risk.

Patients with AFib often have had to make a difficult choice, said Dr. Brad Mikaelian, a cardiac electrophysiologist at Memorial who was the first in southern Colorado to perform the Watchman procedure.

“For many of these patients it’s choosing between a rock and a hard place – ‘well I don’t want to run the risk of a stroke so I should be on those blood thinners, but I have had bleeding problems from the blood thinners and so how do I choose between these two things?’” Mikaelian said. “Finally, with Watchman, we’re able to offer people a third option – a way out of that dilemma.”

Coble’s health issues began over the summer, when a doctor in North Carolina diagnosed him with AFib. The doctor immediately prescribed blood thinners to reduce the chances of a stroke.

The side effects from the medications, however, were nearly immediate: Coble started experiencing joint and muscle pain and he felt very weak – so much so he had difficulty playing golf. He ended up in the emergency department more than once and was referred to Mikaelian, who found Coble to be a good candidate for the Watchman procedure.

The Watchman device is about the size of a quarter and looks like a tiny umbrella. It was designed to prevent clots from forming in the left atrial appendage by sealing off this section of the heart where most deadly blood clots form in those with AFib.

Coble had the procedure done in September and spent one night in the hospital. In late October at a follow-up appointment, he learned he is cleared to go off blood thinners.

“The only downside to [the Watchman procedure] was I couldn’t play golf for a week,” Coble said. But before the procedure, he no longer had the energy for the game and certainly wasn’t able to walk 18 holes, as he was accustomed to doing.

“It got to the point with Coumadin [a blood thinner] that I didn’t even play because walking from the cart to the green was, you know – I felt like I was going to pass out. Now I can play golf. I played 11 holes the other day and I’m feeling better every day.”

To implant the device, Mikaelian and a specialized cardiac team insert it through a catheter in a vein in the upper leg and guide it to the heart. The device crosses from the right side of the heart to the left side before it is positioned in the correct spot in the left atrial appendage.

The procedure is done under general anesthesia and typically lasts about an hour. Afterward, patients stay in the hospital overnight, and recovery takes about 24 hours. About six weeks after the procedure, the patients are reassessed to determine if the device has successfully closed off the left atrial appendage, and then the patient can reduce or stop taking blood thinners.

“The fun of this procedure is the follow-up six weeks later — at that point being able to talk to patients and tell them ‘everything looks great. You can stop taking blood thinners,’’’ said Mikaelian. “It’s very exciting.”

Since the first case in August, Mikaelian has performed 21 procedures.

“There are some patients who have to stay on blood thinners longer, but the data says that after one year 99 percent will come off blood thinners,” said Mikaelian.

Mikaelian added the Watchman technology will benefit a large number of high-risk patients in the Pikes Peak region. Memorial’s association with UCHealth is key in the hospital’s ability to offer the procedure to patients, enabling them to have the best care, close to home, he added.

Coble felt well enough after the procedure to travel to Minnesota, where he was a marshal in the 2016 Ryder Cup.

“After going through my experience, I am happy to have done this [rather] than have taken blood thinners the rest of my life,” Coble said. “I thank the Lord for that man,” Coble said of Mikaelian.

And Coble’s golf game is going well. In fact, he recently had one of his best games ever.

About the author

Cary Vogrin is a writer for UCHealth and is based in Colorado Springs.