- Hi, I'm Asheel Eschol.
I'm one of the interventional cardiologists here
at Centerpoint Medical Center.
And I'm here today with Dr. Scott Koerber.
Who's an electrophysiologist.
We have a new technology that we're bringing
to Centerpoint that allows some patients
with atrial fibrillation to come off
of their blood thinners.
And we'd like to tell you a little bit more about it.
So I thought we could start
out by introducing you to the atrial fibrillation.
So, Dr. Koerber, can you tell us a little bit more
about atrial fibrillation
and what's important to patients regarding?
- Sure, sure.
So as Dr.Asheel said, my name is Dr. Koerber.
I'm one of the heart rhythm doctors
kind of heart rhythm specialist.
So heart rhythm issues such
as atrial fibrillation is our specialty.
So first off atrial fibrillation is the most common
a rhythm in the world, and it's mainly a disorder
of the top two chambers of the heart.
So if you picture the heart
you have two top chambers and two bottom chambers.
So when, when the normal heart is beating
the normal pacemaker from the heart
starts in the top right chamber
and that squeezes and that fires automatically
and it sends that signal to both top chambers
to make the top chambers squeeze a rhythmically.
Okay, and then from there, that signal goes
from the top chambers down to the bottom chambers
via another connection called the AP note.
So a normal heartbeat starts is the top chamber squeezing
and then the bottom chamber nice and rhythmic.
The problem with atrial fibrillation
is that you have an extra beat that usually comes
in from one of the top left chambers.
And so if it kind of short circuits, the whole top chamber
so instead of the top chamber squeezing nice
and slow and rhythmically that extra beat comes
in and makes them quiver.
So then instead of having that nice control top chamber
the atrial beating it just quivers
and then the bottom chamber beats erratic.
And so there's a couple
of problems with atrial fibrillation
and the most feared one is a stroke.
Because the blood is not squeezing
out of the top chamber it's quivering.
And so blood is pooling in the top chamber.
And if blood pools in there long enough
it form a blood clot in therefore a stroke.
And so that's why a lot of our patients
that have atrial fibrillation
are all on blood thinners,
such as Xarelto, Pradaxa, Eliquis, Coumadin.
The point of that is to quote, quote thin the blood
in order to prevent a blood clot
from forming in that top chamber.
- And so the blood thinners are very good, and we understand
from thousands of patients that they're generally safe
and really the best way to prevent stroke
if a patient can tolerate them.
But as you can imagine
sometimes patients can't take blood thinners.
- Yeah.
- And in those patients
there's a really good suitable alternative.
That's been available since about 2015
but it's gradually been implanted in thousands of patients.
It's called a left atrial appendage closure procedure.
And this procedure addresses a small pouch
in the heart called a left atrial appendage.
This little pouch is where most
of the large strokes come from.
And instead of using a blood thinner to prevent clots
from forming in that pouch, we can put a device
into that pouch and seal it off
so that clots don't form and we can prevent stroke.
And this procedure is something that is done
in the hospital and it takes about one hour.
We bring a catheter, a hollow tube from the leg vein
bring it up to the heart
and go into this little pouch
and then deploy the device.
It takes about one hour
and the patients recover over a one night stay
in the hospital and they are released to home the next day.
Can you tell us a bit about the procedural, any risks
or benefits from this procedure compared to blood thinners?
- Yeah, so like Dr. Asheel was just saying it's been studied
in thousands of patients and the risk
and efficacy of the device has been shown
to be non-inferior to blood thinners, particularly
in those patients that can't tolerate blood thinners.
And so some patients that might be
in that category would be patients that have
any bleeding issues such as GI tract bleeding.
So blood in your stools, any patients that are
have balance issues that have frequent falls
or any people that have some sort of anemia
or problem that they have to get blood transfusion.
So there's more that can be included in that category
but those are kind of the highlights of those patients.
- And in terms of the comparison
to blood thinners, you'll notice
that the stroke risk is about the same in both groups
if people who get blood thinners versus the procedure
but the procedure does have some small risks
that we would review with you before going forward.
- Yeah.
So, you know, I think the next step
for any patients that may be interested in this,
if you're, if you are a patient that has atrial fibrillation
and that are on blood thinners
and you have con some concerns about these blood thinners
there's a number that you can call
at the bottom of the screen, and we can get
get in touch with you from there
and then maybe schedule an appointment to
discuss further options going forward with anticoagulation
versus if you may be a candidate for this procedure.