As an electrophysiologist (a heart doctor specializing in rhythm disorders) I treat many patients with atrial fibrillation (AFib), the most common abnormal heartbeat. When I diagnose someone with AFib, they often worry about how it will impact their heart health.
But some of my new patients don’t know that their heart condition may also pose a serious risk to their brain. And those patients aren’t alone: Nearly a third of people with AFib don’t know that the condition can cause a stroke.
I always reassure my patients that controlling their condition can help to lower their risk for stroke and other serious complications of AFib — but I also make sure they understand the risks of leaving AFib untreated.
The truth is that people who have untreated AFib are up to five times more likely to have a stroke than someone without the condition. And strokes caused by AFib are often more serious than other strokes. In fact, AFib-related strokes are estimated to be twice as likely to cause disability or death — so it is very important to manage AFib closely.
Here’s what I tell my patients about the connection between AFib and stroke and how treatment can help to reduce the risk.
A heart out of sync
When I explain the link between AFib and stroke, I start with how AFib affects the heart.
AFib is a problem with the heart’s natural electrical signals. When those signals are working correctly, they allow the heart muscles to contract smoothly and rhythmically, moving blood efficiently through the heart’s four chambers.
When a person has AFib, the heart’s two upper chambers, called the atria, squeeze and relax quickly, irregularly, and highly inefficiently. As a result, blood doesn’t circulate in the top chambers of the heart very effectively, and when blood does not move it tends to form clots.
These blood clots can break free and travel through the bloodstream to other organs. When a clot travels to the brain, it can trigger a stroke.
Preventing blood clots
One of the most effective ways to prevent AFib-related strokes is to stop the clots that cause many of them in the first place.
To accomplish that, I often prescribe blood thinners (sometimes called anticoagulant medications) to my patients with AFib. Examples of these drugs include apixaban (Eliquis) and rivaroxaban (Xarelto). Older medications such as coumadin (warfarin) are no longer used with much frequency.
When I prescribe blood thinners, I advise my patients that it’s crucial that they take them just as prescribed — even if they don’t feel any symptoms of their arrhythmia. AFib raises the risk of stroke, even among patients who don’t experience symptoms such as faintness or a racing heart.
A one-time procedure reduce stroke risk
Blood thinners are an effective option, but they’re not right for everyone. They can cause unwanted side effects, such as an increased risk of bleeding internally. In addition, some people do not tolerate these medications well. At Temple Health, we offer a leading-edge alternative for patients whose AFib is not caused by a heart valve problem: the Watchman device.
How the Watchman device helps prevent stroke
To understand how the Watchman device works, it’s important to know how AFib increases stroke risk. AFib can prevent the heart from pumping blood normally, causing blood to pool in an area of the heart called the left atrial appendage (LAA). The Watchman device seals off the LAA, preventing blood from pooling and forming clots, which is an effective way to help prevent strokes.
About the Watchman procedure
The Watchman device is implanted in the heart during a minimally invasive procedure. The device, which is about the size of a quarter, is designed to prevent blood clots from forming. Despite its small size, the Watchman offers significant benefits:
- Stroke Risk Reduction: The Watchman reduces stroke risk as effectively as warfarin.
- Discontinuation of Blood Thinners: Most patients can stop taking blood thinners within a few months after the Watchman is implanted.
- Durability: The device never needs to be replaced.
- Lifestyle Flexibility: There’s no need to avoid certain foods or activities, and patients require fewer blood tests.
What to expect during the Watchman procedure
When recommending the Watchman, I ensure my patients understand what to expect during and after the procedure.
To implant the Watchman, I begin by inserting an IV into a vein at the top of your leg, followed by a catheter (a thin, flexible tube) that is guided through the blood vessels to the LAA. Using this catheter, the Watchman device is inserted into the LAA, where it opens like an umbrella to form a seal.
After the Watchman Procedure
The Watchman implant procedure is performed under general anesthesia, so you won’t be awake. It takes about an hour, and patients typically leave the hospital the next day.
Most people can stop taking blood thinners just 45 days after the Watchman procedure. By that time, the heart's tissues have grown over the Watchman, forming a permanent barrier against clots. When we determine you’re ready to stop blood thinners, you'll take a medication called clopidogrel (Plavix) along with aspirin for six months. After that, aspirin is usually the only blood thinner needed.
Reclaim your rhythm
If you have AFib, the right treatment can help you reduce your risk of stroke and other serious complications. At Temple Health’s Arrhythmia Program, our experienced heart specialists offer decades of experience and a full array of leading-edge treatment options — including the Watchman device. Temple cardiologists are also among the most experienced in the region at performing Watchman implants.
To make an appointment with a Temple expert, call 800-TEMPLE-MED (800-836-7536) or request an appointment online.
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