Atrial fibrillation (also known as “AF” or “A-Fib”) is a type of irregular heart rhythm or arrhythmia that affects over 30 million people worldwide and is a leading cause of deadly strokes, particularly in the elderly.
With atrial fibrillation, the heart may not be able to pump blood normally. This can cause blood to pool in a small pouch that sits off the left side of the heart, known as the left atrial appendage (LAA), and form a clot. If left untreated, the clot can enter the bloodstream, travel to the brain and cause a stroke.
To reduce the risk of stroke, physicians often prescribe a blood-thinning medication, or anticoagulant. These medications slow down or prevent blood cells from clumping together to form a clot. But they may not be appropriate for everyone.
“Despite their effectiveness, taking blood thinners may be difficult for some patients,” says Dr. Sheldon Singh, a cardiac electrophysiologist at Sunnybrook’s Schulich Heart Centre. “These medications are not always well-tolerated and they present a risk for bleeding complications.”
How a unique heart device can help prevent stroke
A treatment called the Watchman™ implant is an alternative to blood thinners. It is designed to permanently seal off the appendage in the heart where blood clots can form.
“This procedure can protect those who are at a high risk of stroke from atrial fibrillation but who either cannot take blood thinners, or cannot take them consistently for a long period of time,” says Dr. Singh. “Studies have shown that, on average, people who got the implant lived longer than those on some blood thinners, likely caused by life-threatening bleeding.”
In the minimally-invasive procedure, a specialized device is guided by a catheter through a vein in the upper leg and into the left side of the heart. Once in position, the implant is released and seals off the left atrial appendage. Over time, heart tissue grows over the device to create a permanent barrier. The procedure typically takes an hour, with only a 24-hour recovery time.
More procedures, more lives
In the five years since Sunnybrook first introduced the minimally invasive treatment, approximately 40 patients have received the device, with the help of donor support.
During that time, a new iteration of the device first used in Ontario by Sunnybrook has made it easier to implant, says Dr. Singh, “which makes the procedure quicker and safer.”
In March 2020, the Ministry of Health announced its decision to fund 20 Watchman cases annually at Sunnybrook, along with five other centres in Ontario, making the life-saving procedure more accessible for patients who need it. After completing all 20 cases within just five months, the Schulich Heart Centre will be resuming the treatment in April 2021.
“With provincial funding and growing capacity, the procedure is gradually becoming a valuable and more commonly accepted alternative,” says Dr. Singh. “This means we have more opportunities to reduce the risk of stroke in people with atrial fibrillation who previously had very few options.”
Global studies are underway
The Schulich Heart Program was recently selected as one of three Canadian centres, and the only Ontario program, to participate in a clinical trial evaluating the Watchman technology. It is also one of only two Canadian centres chosen to participate in a pivotal global trial evaluating the Watchman against blood thinners in the general population with atrial fibrillation. Set to launch in 2021, the U.S.-run trial will involve patients who have received ablation to treat atrial fibrillation. Researchers will compare the outcomes of those who take blood thinners to those who receive the Watchman device.
“If you have atrial fibrillation and you’re looking for an alternative to blood thinners, speak to your cardiologist about your options,” says Dr. Singh.