Keeping Watch Over Your Heart

Implant blocks clots in AFib patients, helps reduce risk of stroke.

The US petroleum industry got its start in the 1860s after the first modern oil well was drilled near a bend in the Allegheny River in northwestern Pennsylvania. The small town around the river came to be known as Oil City.
A little less than a century later, Judy Espy got her start in Oil City as well.

Judy Espy

Judy went on to marry a baker, and the couple raised three boys and a girl they adopted from Korea. Most of Judy’s work as a homemaker was done in Oil City, but for years the family spent its summers elsewhere.

“My best friend since I was 9 years old moved to Bradenton during her senior year of high school, and for years after that I would always go down for visits,” Judy says. “I pretty much raised my children in Florida in the summertime.

“We would stay in Florida most of the summer, and I always wanted to make it a permanent move. I finally bought a house here in 1998. It was after both of my parents had passed and the children were grown that I made the move.”

Long before that, Judy began experiencing random moments during which her heart would beat at an accelerated pace. They usually lasted only a few minutes, but after she moved to Florida the time span increased.

“One of them lasted for five or six hours,” Judy remembers. “That was pretty bad. That’s when I realized I probably needed to do something about this because I had never really been all that bothered before.

“I barely even paid any attention to them when I lived in Pennsylvania, but after I moved to Florida, I started to have these little episodes five or six times a day. And I couldn’t do anything when they happened because I had to lie down and relax.”

Upon first seeking medical attention for the problem, Judy was told she had a classic case of atrial fibrillation, an irregular or rapid heart rate that can lead to the formation of blood clots and cause a stroke or heart failure.

Studies show that people with atrial fibrillation, or AFib, are approximately five times more likely to suffer a stroke than those who do not have it and that by 2030 approximately 12 million people in the US will have AFib.

AFib is considered to be the most common form of irregular or rapid heart rate, and while some who have it may experience no symptoms at all, others could experience dizziness, shortness of breath, lightheadedness and chest pains.

After first diagnosing Judy with this condition, her doctors chose to simply “keep an eye on” her situation. As Judy’s symptoms worsened, her doctors felt the need to monitor her situation more closely.

“They gave me a monitor to wear, and as soon as one of those episodes would start, I pressed a button on it, and the monitor kept track of how long the episode lasted and what my heart rate was,” Judy explains. “It would then send the information to the hospital.”

The monitor allowed Judy’s doctors to keep tabs on her AFib, but it did nothing to resolve it. For that she was soon placed on blood thinners and underwent an ablation procedure, where scar tissue is created within the heart. The scar tissue blocks the abnormal electrical signals and reduces the chances of the irregular or rapid heartbeat occurring again. Before long, though, Judy’s doctors offered her a better option: the Watchman™ left atrial appendage closure (LAAC).

Best of Both Worlds

“The Watchman is a device that gets placed into the heart, where it mechanically blocks the blood clots that form in response to atrial fibrillation,” educates Daniel E. Friedman, MD, FACC, FHRS, a board-certified clinical cardiac electrophysiologist and the medical director of the Watchman program at Manatee Memorial Hospital.

“Those blood clots can travel through the heart, up to the brain and cause a stroke,” Dr. Friedman adds. “But the Watchman prevents those strokes from happening by literally catching the blood clots, which are essentially reabsorbed by the body over time.

Watchman FLX™ Implant

“Candidates for this procedure are patients who have atrial fibrillation, whether it be intermittent or all the time, and have risk factors for stroke with their atrial fibrillation such as diabetes, high blood pressure or previous stroke. The best candidates are patients who cannot take blood thinners safely long term or someone who has major bleeding problems with blood thinners.”

The Watchman is larger than a nickel but smaller than a quarter with a fabric top. It’s inserted into a small pouch in the heart called the left atrial appendage through a catheter during a procedure typically completed in about an hour.

The device received its approval from the Federal Drug Administration in 2015. Almost immediately, Manatee Memorial Hospital began its Watchman program. Since then, Dr. Friedman has implanted more than 400 at the hospital.

“We wanted to be the first to do this procedure because we had so many patients who could not take blood thinners long term and therefore were at great risk for a stroke,” says Dr. Friedman, a member of the Structural Heart Team at Manatee Memorial.

“Another reason we wanted to do it is because it represents a paradigm shift in the treatment for AFib. The Watchman not only prevents a stroke, it also prevents bleeding, in essence because patients receiving it no longer need to take the blood thinners.

“It offers AFib patients the best of both worlds. There’s also a cost-effectiveness aspect to it, because research shows that within a few years, patients break even in terms of the cost of getting the Watchman versus taking blood thinners.

That’s why this is something that’s going to be done more and more as time progresses. At Manatee Memorial Hospital, we have a great team involved in the implantation of the Watchman device.

“Not only do we have the nurses and the nurse practitioners we need to perform this procedure, but we also have at least three cardiologists who perform this procedure on a routine basis. Manatee Memorial Hospital is perfectly outfitted with everything we need.

“In fact, I would say that if someone is going to have this procedure done, Manatee Memorial Hospital is the place to go. It’s an effective procedure, and Manatee Memorial Hospital’s complication rate is less than the national average, which is less than half of 1 percent.”

Reducing Stroke Risk

Like blood thinners, the Watchman doesn’t correct the heart’s electrical malfunction, which hinders its ability to pump blood, allowing blood to pool and clot in the left atrial appendage. The Watchman’s purpose is to take away the increased risk for stroke that the blood clots create. As a result, patients still need to take medication to control irregular heart rhythm, and many are also advised to take an aspirin a day.

“I read up on it before I had the procedure done, so I was confident it was going to work well for me, and it has,” Judy exudes. “I’d say it’s one of the best things I ever did for myself because it works great.

“I have had maybe three episodes of rapid heartbeat since the Watchman was implanted by Dr. Friedman. But none of them have been like they were before. They lasted just a few seconds, and that was it, so I’m very happy with how
it’s all worked out.

“And I’m very happy with the work that Dr. Friedman and everyone at Bradenton Cardiology and Manatee Memorial Hospital did. They’re all exceptional people, and Dr. Friedman is very persistent.

“He’s very friendly, and I really appreciate that he answered all the questions I had about how the Watchman worked and how the surgery was done. He’s a great doctor I gladly recommend. I think he’s great.”

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