Alternatives to Blood ThinnersJan 31, 2019
Two Fixes for AFIB
A typical human heart beats 60-100 times per minute, where a person’s heart with atrial fibrillation can cause the lower chambers to beat at speeds of up to 100-175 times per minute. People with AFIB can experience racing heart, palpitations, dizziness, shortness of breath, episodes of passing out, extreme fatigue and chest pain among other symptoms. Sadly, for some with AFIB, their only symptom may be stroke or death.
For people who manifest symptoms and are diagnosed with AFIB, many are prescribed medication to manage their condition including anti-arrhythmic drugs to slow the heart rate and blood thinners to reduce the risk of blood clots and stroke. But prescription medications do not come without side effects and they often only treat the symptoms. What if there were alternatives to taking medication for life?
Desert Care Network electrophysiologist Hetal Bhakta, MD, will be discussing alternatives to blood thinners for atrial fibrillation on two dates coming up:
- February 26, 9:30 a.m. at Sun City Palm Desert in Palm Desert
At the seminar, Dr. Bhakta will discuss two minimally-invasive treatment options that provide a lasting solution for those suffering with AFIB:
- Robot-guided catheter ablation
- Implantation of the Watchman device
Dr. Bhakta describes the heart as a four-bedroom house; two bedrooms upstairs – the atrial chambers, and two bedrooms downstairs – the ventricle chambers. In a healthy heart, the upper chambers squeeze and fill the bottom chambers with blood, and then the lower chambers squeeze again pushing the blood to flow throughout the body. With AFIB, when the heart is running at higher speeds, it causes the atrial chambers to quiver and does not squeeze the blood as well to fill the lower chambers.
The lower chambers beat faster than normal which can cause dizzy, light-headed, or racing feelings. Because the blood does not move as well, it tends to clot when it stagnates in the upper left chamber. If a clot dislodges, it can travel into the brain and cause a stroke. This is why people with AFIB are prescribed blood thinners.
“Your body is controlled by an electrical system in the heart. It’s no different than an electrical system in a house,” said Bhakta. “The sinus node is like a light switch. You flip the switch and the bulbs come on at the same time and the whole room lights up.”
But as we age, things like blood pressure problems, heart attack, valve problems and diabetes affect the heart, causing damage.
“The electrical wires start breaking down and you get shorts,” he said. “When some of the ‘bulbs’ start shorting out, it overloads the system and one bad bulb turns into more,” Bhakta said.
This is why Dr. Bhakta recommends people get the damaged area of the heart fixed with ablation as soon as possible before more damage can occur, as medication does not correct the circuitry issues. “If we treat it early, we’ve virtually taken care of the problem – it’s a cure instead of an ongoing treatment,” said Bhakta.
The majority of ablation procedures in the United States are performed manually, which has a slight risk of perforation (1.0%). At Desert Regional Medical Center, the procedure is performed utilizing the latest technology by Stereotaxis in guided robotic catheter ablation. The better movement around the heart with the robotic arm contributes to a safer procedure and the magnetic technology hones in for greater accuracy.
Four to six hours after an ablation procedure, the patient is up walking and they typically go home the next day. The only restrictions are no heavy lifting or running for one week. After that, they can go back to all activities with no restrictions.
Another newer treatment for AFIB is implantation of the Watchman device, recommended for those who cannot tolerate blood thinners. Back to the house illustration, Dr. Bhakta explains that in the upper-left atrial chamber there is a “closet with crevices” – or atrial appendage in medical terminology – where the clots tend to accumulate in a person with AFIB.
“It’s kind of like a cul de sac,” Bhakta said. When blood clots get trapped in this area, they occasionally dislodge and this is when they can travel to other parts of the body through the blood stream.
Before the Watchman, “People with AFIB who couldn’t’ tolerate blood thinners would just have to wait and hope they didn’t get a stroke,” said Bhakta.
“We know that 90% of the clots happen in the ‘closet area’,” said Bhakta. “With the Watchman procedure, we go in and seal the ‘closet’ by implanting this pronged device which attaches to the heart muscle and the body endothelializes that area (tissue grows over it).”
Ablation and the Watchman device are complementary procedures addressing the two main problems of atrial fibrillation. Ablation addresses the abnormal rhythm issue and the Watchman addresses issues of blood clots and strokes. While some people will only need an ablation, those who cannot tolerate blood thinners can have the Watchman implanted first to seal off the atrial appendage to reduce the risk of a blood clot. Then later, they can have an ablation to correct the circuitry issues.
“If you don’t know what the options are, you don’t know what to ask for,” said Bhakta who wants to educate people on what is available right here in the Coachella Valley. “These are very cutting-edge procedures, they are not garden variety things. I want people with AFIB to know that there are options for them to correct the problem and to be able to get off medication.”
If you are one of the nearly 2.7 to 6.1 million Americans affected by atrial fibrillation, plan to join Dr. Hetal Bhakta for a fascinating presentation about these new treatment options.