A new way to reduce stroke

How Does AFib Increase Stroke Risk?

More than 6 million Americans experience atrial fibrillation, including nearly one in 10 people older than age 65. Known as AFib for short, atrial fibrillation is a heart rhythm disorder, and it can result in a variety of serious medical conditions, including heart failure and stroke. The average person with AFib is five times more likely to have a stroke than someone with a regular heartbeat.1 That’s because AFib can decrease the heart’s pumping capacity by as much as 30%.2 Because blood isn’t pumped out of the heart normally, it’s easier for blood cells to stick together and form clots in an area of the heart called the left atrial appendage (LAA).2, 3 When a blood clot escapes from the LAA and travels to another part of the body, it can cut off the blood supply to the brain, causing a stroke.1, 4

In people with atrial fibrillation not caused by heart valve problems (the most common type of AFib), more than 90% of stroke-causing clots that come from the heart are formed in the LAA.3

Reducing AFib Stroke Risk

Blood thinners, also called anticoagulants, are an effective way to lower the risk of stroke in people with atrial fibrillation not caused by heart valve problems.5 But some people need an alternative to blood thinners, because they can increase the risk of bleeding5 or stroke.

If you have a history of bleeding or a lifestyle, occupation or condition that puts you at risk for bleeding, your doctor may consider an alternative to blood thinners. Left atrial appendage closure (LAAO) devices are designed for reducing strokes. The devices are also sometimes referred to as LAAC’s, or left atrial appendage closure. One type of this device is WATCHMAN.

Community was first in Indiana to perform the WATCHMAN FLX and WATCHMAN FLX Pro procedures. Since 2016, Community has performed more than 800 WATCHMAN procedures.

Online Seminar

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Watch an informative online presentation about the LAOO procedure that reduces the risk of stroke in people with non-valvular Afib.

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Are You at Risk for Stroke?

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A stroke is like a heart attack in the brain. To find out your personal risk of a stroke, answer a few simple questions about your health and lifestyle.

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LAAO Devices: An Alternative to Blood Thinners

The LAAO treatment is a one-time, minimally invasive procedure for people with atrial fibrillation not caused by a heart valve problem (also known as non-valvular AFib) who need an alternative to blood thinners. The device is about the size of a quarter and made from very light and compact materials commonly used in many other medical implants.

Michael Robertson, MD, an interventional cardiologist at Community Heart and Vascular Hospital, explains that this goes right to the source of stroke risk for AFib patients. “Clots tend to form in a muscle pocket in the left atrium for AFib patients,” he says. In fact, it’s estimated that 90 to 95 percent of the clots linked to AFib start out in this area.

“A left atrial appendage closure device is essentially a plug that is put into that muscle pocket to permanently seal it off from the rest of the heart chamber,” Dr. Robertson explains. With that breeding ground for clots sealed off, the risk of stroke goes down significantly. It’s ideal for those who can’t take blood thinners—and for those who have been on blood thinners, the implants often make the medications unnecessary.

Patient Benefits

  • LAAO is a one-time safe alternative procedure that reduces the risk of stroke in people with non-valvular atrial fibrillation.
  • LAAO is as effective at reducing the risk of stroke as prescription blood-thinning medication therapy. The implant also reduces the long-term risk of bleeding. Newer blood thinners exist, but don’t take away the long-term risk of bleeding.
  • In a clinical study, more than 96% of patients were able to stop taking prescription blood thinners just 45 days after receiving the implant.
  • The device is sized to allow for treatment of larger appendages.

Learn More

If you would like more information about this procedure, please contact the program coordinator at 317-621-8489.

The Procedure

  • The  procedure is typically performed under general anesthesia in a catheterization laboratory setting using transfemoral access and a standard transseptal technique.
  • The  procedure usually lasts about an hour to 90 minutes and the patient is typically in the hospital for 24 hours.
  • Patients remain on prescription blood thinner medication for at least 45 days post-procedure until the device is endothelialized.
  • By closing off the left atrial appendage, the risk of stroke may be reduced and, over time, patients may be able to stop taking anticoagulants.
  • The implant, made by Boston Scientific, was approved in 2015 by the U.S. Food and Drug Administration (FDA). Community Heart and Vascular Hospital started serving WATCHMAN patients in 2016. Medicare covers the procedure.

Learn more in this video.

Meet the Physicians

Robert William Godley, MD

Bill Godley, MD, cardiologistDr. Bill Godley grew up in Fort Wayne, IN prior to receiving his bachelor degree from Northwestern University in Evanston, IL. He then went on to attend medical school at the Indiana University School of Medicine in Indianapolis, where he graduated with honors. Following this he completed his internal medicine residency at the University of Michigan in Ann Arbor. To round out his training, Dr. Godley completed general and interventional cardiology fellowships at the Texas Heart Institute in Houston, TX, where he served as chief cardiology fellow.

Dr. Godley has an interest in all areas of cardiac and vascular interventional medicine – including complex coronary and peripheral revascularization, as well as minimally-invasive interventions for structural and valvular heart disease.

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Krishna C. Malineni, MD

Krishna Malineni, MD, cardiologistDr. Malineni, board-certified cardiologist, joined Community Heart and Vascular in 2010. Previously, Dr. Malineni served as an electrophysiologist at Illinois Heart and Vascular in Hinsdale. He completed his fellowship in cardiology at the Rush University Medical Center in Chicago, Illinois and his fellowship in electrophysiology at Aurora Sinai Medical Center in Milwaukee, Wisconsin. He completed postgraduate training in internal medicine at Henry Ford Hospital in Detroit., where he was chosen as chief resident. Dr. Malineni attended Wayne State University, where he earned both his medical degree and bachelor of science in biology.

He is board certified in internal medicine, cardiovascular medicine and cardiac electrophysiology.

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Anil Purohit, MD

Anil Purohit, MD, electrophysiologistDr. Purohit is a board-certified cardiac electrophysiologist and specializes in management of cardiac arrhythmias ranging from medical management to cardiac implantable devices such as pacemakers or defibrillators (AICDs) and radio-frequency catheter ablations. Dr. Purohit completed his medical degree at the University College of Medical Sciences in New Delhi, India. He completed internal medicine residency training and a general cardiology fellowship at the University of Iowa, Iowa City. He then completed a cardiac electrophysiology fellowship at UCLA.

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Michael A. Robertson, MD

Michael A. Robertson, MD, cardiologistDr. Robertson, interventional cardiologist, began his medical career in 2006. He served his fellowship in both cardiovascular disease and interventional cardiology at the University of Colorado. He also served his internship and residency in internal medicine at the University of Colorado. Dr. Robertson graduated from the University of Wisconsin School of Medicine.

He is board certified in internal medicine, cardiovascular disease and interventional cardiology.

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Kevin M. Trulock, MD

Kevin Trulock, MD, cardiologist and Watchman specialistDr. Kevin Trulock completed his bachelor of science in biology from Indiana University and represented the Hoosiers as the place kicker on the football team. He went on to complete his doctorate in medicine from Indiana University School of Medicine, where he graduated with honors. After this, he completed his internal medicine residency at Duke University. Dr. Trulock returned to the Midwest to complete his cardiovascular medicine and cardiac electrophysiology fellowships at the Cleveland Clinic Foundation, where he served as chief fellow.

Dr. Trulock’s areas of expertise include lead extraction, complex atrial and ventricular ablations, as well as pacemaker, ICD and biventricular device implantation and management.

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Sources

  1. National Stroke Association. Making the Afib-Stroke Connection. https://www.stroke.org/sites/default/files/resources/Afib-Connection%20for%20hcp.pdf. Published 2012. Accessed September 1, 2016.
  2. Harvard Health Publications. Atrial fibrillation. http://www.health.harvard.edu/heart-health/atrial-fibrillation-common-serious-treatable. Harvard University Medical School. Published November 2011. Accessed August 25, 2016.
  3. Blackshear JL, Odell JA. Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. Ann Thorac Surg. 1996;61:755-759.
  4. Cleveland Clinic. Atrial fibrillation (Afib). http://my.clevelandclinic.org/services/heart/disorders/arrhythmia/atrial-fibrillation-afib. Published May 2015. Accessed August 25, 2016.
  5. National Stroke Association. Making the Afib-Stroke Connection. https://www.stroke.org/sites/default/files/resources/Afib-Connection%20for%20hcp.pdf. Published 2012. Accessed September 1, 2016.
  6. PINNACLE FLX 12-month primary safety and efficacy endpoint results, Doshi, SK. presented at HRS 2020 Science.