If you’re one of nearly 5 million Americans who suffer from atrial fibrillation (Afib), blood thinners are one way to limit your risk of stroke; however, not everyone can tolerate these medications. The good news is there are other treatment options available.
Yoaav Krauthammer, MD, a cardiac electrophysiology specialist with HonorHealth Heart Care, shares his knowledge of Afib treatments in this informative Q&A.
Q. What is Afib?
A. Normally, the electrical signal that causes your heart to beat moves through your heart in an organized way. When you have Afib, the signal in your top two heart chambers (atrium or atria) is disorganized, leading to an irregular and fast heart rate.
Q. What are the symptoms of Afib?
A. While some patients may not have symptoms caused by Afib, others may experience:
- Palpitations (a sense of a racing and irregular heartbeat)
- Fatigue
- Chest pain
- Shortness of breath
- Fainting
- Dizziness
Q. What are the risks of Afib?
A. While not often immediately life threatening, Afib can result in a number of risks, including putting you at a greater probability of having a stroke – five times more than someone without it. If unrecognized or untreated, a rapid heart rate caused by Afib may lead to the weakening of your heart’s function (cardiomyopathy).
Q. How is Afib commonly treated?
A. A key treatment is the administration of blood thinners (anticoagulants). Afib can cause the blood flow in the atria to become stagnant, leading to the formation of clots which can travel outside of your heart and to your brain, causing a stroke. Blood thinners help reduce your risk by preventing the formation of clots.
Q. How do blood thinners work?
A. Blood thinners work by blocking certain factors or agents that are essential in the formation of clots. Vitamin K plays a vital role with helping your blood clot. The drug warfarin blocks your body’s use of vitamin K, thus preventing clots from occurring. Newer agents, called direct oral anticoagulants (DOACs), inhibit other factors in the clotting process, separate from vitamin K.
Q. What are the risks of taking a blood thinner long-term?
A. The use of a blood thinner increases your risk of bleeding, including life-threatening conditions such as bleeding within the skull (intracranial hemorrhage).
Q. What’s the risk of stroke in patients who take blood thinners?
A. Blood thinners can reduce your risk by as much as 50-60%.
Q. Are there any alternatives to the blood thinner, warfarin?
A. Direct oral anticoagulants (DOACs) are now recommended over warfarin unless you have a prosthetic heart valve or moderate-to-severe narrowing of the mitral valve. These drugs include rivaroxaban, apixaban, dabigatran and edoxaban.
Q. Are any other treatments available?
A. If you are unable to tolerate blood thinners, there is an alternative available. The Watchman™ device is an implant, about the size of a quarter, which closes off your left atrial appendage where most clots form.
Q. What is the left atrial appendage, and what does it do?
A. The left atrial appendage is a small chamber extending from the main section of your left atrium. The function of the left atrial appendage is unclear; however, it may function as a sort of decompression chamber for your left atrium.
Q. To implant the Watchman™, what type of medical procedure is involved?
A. A cardiologist delivers the Watchman™ device to your heart using a catheter through the femoral vein in your groin.
Q. What type of anesthesia is required?
A. General anesthesia is most commonly used, enabling the cardiologist to control your breathing and test the device once it’s placed in your left atrial appendage.
Q. How do you know if you qualify for the procedure?
A. You should consult your primary care doctor or cardiologist. If you have Afib, which is not due to heart valve disease, and you have experienced significant bleeding while using blood thinners, or have other intolerances to these types of medications, you may be a candidate for the Watchman™ device. In addition, if you have any conditions that may increase your risk of being on a blood thinner, such as balance issues resulting in frequent falls, then you may also qualify.
Q. Is the Watchman™ device FDA approved?
A. Yes, the U.S. Food and Drug Administration approved it for commercial use in 2015.
Q. What are the benefits of the Watchman™ implant?
A. The Watchman™ device can effectively reduce your risk of Afib-related stroke. You will need to take a blood thinner for 45 days after the procedure until your doctor confirms that your left atrial appendage is permanently closed, then you will be taken off the medication.
Q. How do I know which treatment option is right for me?
A. It’s important to talk to your doctors about your treatment options for Afib.
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