Dr. Adam Chodosh discusses atrial fibrillation and the Watchman procedure, a treatment alternative to traditional blood thinners for certain patients.

What is atrial fibrillation?

Atrial fibrillation (AFib) is an irregular quivering, and sometimes rapid, heartbeat or rhythm. It occurs when there is a chaotic distribution of electricity and the two atria, top chambers of the heart, beat irregularly and out of sync with the lower chambers called the ventricles. The heart is less effective at moving blood from the atria to the ventricles, which can lead to clot formation and resulting strokes. Symptoms include chest pain, heart palpitations, extreme fatigue, dizziness or light-headedness, and shortness of breath. AFib, in general, increases a patient’s stroke risk by five times. Once diagnosed with AFib, a patient receives a score to determine their personal risk of stroke and their best treatment options.

What is a CHADS2 score?

The CHADS2 is a 2001 scoring system to predict a patient’s risk of stroke. The acronym stands for Congestive heart failure, Hypertension, Age (>74), Diabetes, and Stroke, where a previous stroke gets two points and each other factor earns one point. The higher the score is, the higher the patient’s risk of stroke. An updated version called the CHA2DS2-VASc was proposed in 2006 and takes additional factors into account. In patients with AFib, 90 percent of strokes are caused by a clot formed in an area of the heart called the left atrial appendage (LAA). A clot can break loose, travel and block off blood flow to the brain, resulting in a stroke.

What is the Watchman procedure?

The Watchman is a minimally-invasive procedure that inserts a small device into the LAA. The Watchman implant acts as scaffolding for the body’s own tissue formation, which grows over the implant blocking off that area of the heart from the bloodstream. Once the LAA is occluded, or blocked off, clots can no longer form in the appendage and stroke risk is reduced.

What is involved in the procedure?

The procedure is done under anesthesia with medical imaging guidance, such as fluoroscopy. A small incision is made in the leg of the patient to gain femoral artery access. A plastic tube is inserted into the artery and guided to the heart. Once in the left atrium, contrast dye is used to better visualize the shape of the LAA and determine what size implant is best. The implant is inserted, positioned, then released and the tube is removed. The procedure can be done in as little as 30 minutes and patients typically only stay one night in the hospital.

Why is the Watchman helpful?

The Watchman greatly decreases the stroke risk of patients with AFib. Strokes that do occur after a Watchman implant is placed are less disabling and often not fatal. The Watchman procedure can also replace the need for continuous use of blood thinners. This is advantageous to many older and sicker patients that cannot tolerate the level of bleeding risk that comes with the use of blood thinners. An exciting new updated version, called the Watchman Flx, offers physicians the ability to recapture, reposition and redeploy the device improving the safety, effectiveness and speed of the procedure.

Dr. Adam Chodosh of the Concord Hospital Cardiovascular Institute is a board-certified physician in cardiovascular disease and clinical cardiac electrophysiology. Dr. Chodosh recently presented on the Watchman procedure for atrial fibrillation at the November Concord Hospital Trust “What’s Up Doc?” Donor Lecture Series. The monthly series, supported by the Walker Lecture Fund, features members of Concord Hospital’s medical staff speaking to Concord Hospital Trust donors about new and innovative medical treatments and services. You can watch Dr. Chodosh’s presentation on Concord Hospital’s YouTube channel at: youtube.com/concordhospital.

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