Six UCHealth patients are the first in Colorado to receive a new heart device that can reduce their stroke risks and get them off powerful blood thinners.
Heart specialists at UCHealth’s Medical Center of the Rockies and University of Colorado Hospital were the first in the state to implant the Watchman, a small, umbrella-like device that prevents clots for people with non-valvular atrial fibrillation.
“The Watchman has the potential to greatly change how we treat atrial fibrillation, and that is why we are so excited about it,” said Dr. Justin Strote, a UCHealth interventional cardiologist who was part of the multidisciplinary team that conducted the first four Watchman procedures at MCR Feb. 9, 2016.
“Five years ago, patients with atrial fibrillation had to accept the risk of bleeding while on blood thinners or stroke if they were off blood thinners,” said Dr. Duy Nguyen, a cardiac electrophysiologist and member of the team that performed the first Watchman procedures at UCH Feb. 19, 2016. “Now we have a third option.”
The Watchman does not treat the atrial fibrillation itself but is rather a procedure that reduces the risk of stroke due to atrial fibrillation, Nguyen stressed.
More than 2.7 million Americans are living with atrial fibrillation, or AFib, a heart condition in which the upper chambers of the heart beat too fast and with an abnormal rhythm. As a result, blood can pool and form clots in an area of the heart called the left atrial appendage. These clots can travel through arteries to the brain and cause a stroke.
People with atrial fibrillation are five times more likely to have a stroke than someone without the condition, according to the Centers for Disease Control and Prevention. Many patients receive blood thinners, such as warfarin, to ward off the risk of a clot breaking loose and traveling to the brain.
“To prevent strokes, we have to prevent blood clots,” Strote said.
But for patients who have already had a stroke or are at increased risk of having one, the blood thinners themselves increase the risk of serious bleeding.
The Watchman device, which is the size of a quarter, is placed in the heart so that it blocks the left atrial appendage and therefore prevents clots.
While the patient is under general anesthesia, a multidisciplinary team uses ultrasound and X-ray to feed a catheter from the upper leg through the femoral vein and into the right atrium. They make a small hole in the septum, pass the catheter through it to the left atrial appendage, position the device, and then release it from the end of the catheter. The Watchman opens, sealing the left atrial appendage. Over time, tissue grows over the Watchman and the area is permanently sealed off. The procedure generally takes one to two hours.
Mae Lewis, of Windsor, was UCHealth’s first patient to receive the Watchman. She arrived at MCR early on Feb. 9 and the next day was celebrating her 79th birthday with friends.
“I felt great,” she said. “And I’m thrilled that I’ll soon be off my prescriptions — just thrilled.”
Lewis struggled for years to find a blood thinner that worked for her. Her body wouldn’t accept warfarin, and weekly doctor visits proved that her warfarin levels were all over the chart. The second blood thinner left her so dizzy she wasn’t able to drive and the third made her vomit.
She finally found one she could tolerate, but her age and other factors established by the CHADS2 scoring tool showed she was at high risk for a stroke and a candidate for the Watchman procedure. These additional criteria include stroke, vascular disease, high blood pressure, and diabetes. The full eligibility guidelines are set by the Centers for Medicare and Medicaid Services, Strote said. These define not only which patients are eligible, but also the requirements hospitals must meet to perform the procedure.
Lewis and other Watchman patients will remain on blood thinners for a period after the procedure, generally 45 days. With careful monitoring, their physicians will decide if they can reduce their use of blood thinners or even stop taking them altogether, Strote said.
But for some patients, the treatment decisions are difficult. Jeff Fogel, 66, of Loveland, was the second patient at UCH to receive the Watchman. He was diagnosed with atrial fibrillation five years ago, after which he suffered a cerebral hemorrhage and two strokes. The setbacks left him in a vulnerable spot. His atrial fibrillation and stroke history increased his risk of a stroke caused by a blood clot, but his cerebral hemorrhage made taking blood thinners too great a risk.
After consulting with Nguyen and evaluating the risks and benefits, Fogel decided on getting the Watchman. Several days after the procedure, he said he felt fine, but acknowledged the short-term need for blood thinners will put him for a time “between a rock and a hard spot.” He said the UCH team is carefully monitoring his blood work to ensure his warfarin dose is balanced.
Nguyen agreed that Fogel “will be in a tight spot” for the 45-day period he is on blood thinners, but added he is recovering well and without complications. As with all patients, there is a small risk that the appendage will not close entirely, but the Watchman trials showed that more than 95 percent of the patients enrolled were able to stop taking warfarin after one year, he said.
Fogel likes his chances. “My appreciation of Dr. Nguyen is boundless,” he said. “He left the decision up to me and made sure that I had everything that I needed to know.”
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University of Colorado Hospital in Aurora
Medical Center of the Rockies in Loveland