>>> BAY STATE MEDICAL CENTER IS OFFERING A NEW PROCEDURE, WHICH
WILL REDUCE THE STROKE RISK FOR PEOPLE WITH THE IRREGULAR HEART
BEAT CONDITION KNOWN AS A-FIB.
I SAT DOWN WITH CARDIOLOGIST DR.
AMIR LOFTI FROM BAY STATE MEDICAL CENTER WHO EXPLAINED THE
PROCEDURE AND BENEFITS.
>> A-FIB IS SOMETHING THAT OCCURS ON THE TOP PART OF THE
HEART.
YOUR HEART IS TOGETHER.
TOP AND BOTTOM FIRE.
IN A-FIB, THE TOP PART OF THE HART
HEART BEATS IRREGULARLY AND FAST, THEREFORE, MAKING THE
BOTTOM OF THE FAST BEAT IRREGULARLY AND FAST.
SURPRISINGLY, UP TO 40% TO 50% OF THE PEOPLE WHO HAVE A-FIB
DON'T EVEN FEEL IT.
SOME OF THE SYMPTOMS IS CHECKING THEIR PULSE AND IT'S FAST AND
IRREGULAR, FEEL SHORT OF BREATH WITH ACTIVITY BECAUSE THE HEART
RATE SHOOTS UP, COULD HAVE CHEST PAIN OR LIGHTHEADEDNESS, AND
DOWNSTREAM THEY DISCOVERED THEY HAVE A
FIB.
>> WHAT CAUSED IT?
>> IT IS ONE OF THE MOST COMMON STATISTICS YOU WILL SEE IS
RELATED TO AGE.
AS WE GROW OLDER, ONE IN NINE PEOPLE OVER THE AGE OF 80 CAN
HAVE THIS.
THAT'S WHY IT BECOMES VERY COMMON.
THE THEORY IS AS THE TOP PART OF THE HEART OVER TIME, JUST LIKE
ANY OTHER PART OF THE BODY, GOES THROUGH WEAR AND TEAR AND HAS
ABNORMAL TISSUE FORMING AND ELECTRICAL CIRCUIT BEGINS TO GET
IMPACTED AND STARTS RANDOMLY FIRING.
>> LIKE A STROKE, FOR EXAMPLE?
>> WHEN YOU HAVE AN IRREGULAR HEART BEAT ON THE TOP WHEN IT'S
NOT BEATING IN A REGULAR FASHION, THERE'S A PART OF THE
HEART ON THE TOP LEFT SIDE CALLED THE LEFT ATRIAL
APPENDAGE, A LITTLE FAT THAT COMES OFF OF IT.
THE BLOOD CAN STAGNATE THERE.
THE STAGNATION CAN FORM INTO A CLOTTED.
THE CLOT CAN GET DISLODGED AND CAUSE A STROKE.
A-FIB, AS DESCRIBED BECAUSE OF IRREGULARLY, THE ONE COMPONENT
IS THE SYMPTOMS, AND THE OTHER COMPONENT IS IT SIGNIFICANTLY
INCREASES YOUR RISK OF STROKE.
>> OKAYMENT CURRENTLY, WHAT'S THE COMMON WAY TO TREAT THIS?
>> SO MEDICATIONS OR SOMETIMES YOU SEE ELECTROPHYSIOLOGY
COLLEAGUES TALK ABOUT MEDICAL THERAPY FOR THE FAST HEART RATE.
FOR THE STROKE PART, YOU TALK ABOUT MEDICATIONS, AND THERE'S
NEWER GENERATION MEDICINES YOU DON'T HAVE TO CHECK YOUR BLOOD
TEST.
THAT MEANS A LOT.
THAT REDUCES THE CHANCES OF HAVING STROKE UP TO 70%.
SO THAT'S THE MEDICATION ROUTE.
NOW, WE HAVE A PROCEDURE ROUTE IN PEOPLE WHO CAN TAKE LONG TERM
BLOOD THINNING MEDICATION, AND THE DEVICE IS CALLED A WATCHMAN.
IT IS A DEVICE THAT LOOKS LIKE A PARACHUTE OR JELLY FISH THAT
FITS INTO THE LITTLE APPENDAGE I TALKED ABOUT, WHERE THE MOST OF
THE TIME THE CLOT FORMS, AND BY SITTING THERE, YOUR OWN TISSUE
GROWS OVER IT AND PREVENTS CLOTS FROM FORMING THERE.
>> AND THIS IS SOMETHING THAT CAN BE DONE IN THE HOSPITAL, BUT
IT'S LAPROSCOPIC PROCEDURE?
>> RIGHT.
WE GO FROM THE GROIN, FROM THE VEIN, UP, INTO THE RIGHT SIDE,
AND THEN UNDER ULTRASOUND WE GO WITH THE NEEDLE TO THE LEFT SIDE
OF THE HEART, IDENTIFY THE LITTLE POUCH, MAKE SURE IT'S THE
RIGHT SIZE, AND DEPTH AND AT THE TIME, PICK THE RIGHT DEVICE TO
IMPLANT THERE.
>> SO THATTISM PLANTS, AND -- SO THAT IMPLANTS, AND HOW LONG DOES
IT TAKE FOR YOUR TISSUE TO GROW OVER IT, AND WHAT DO PATIENTS DO
IN THE MEANTIME AS FAR AS CONTROLLING THEIR CONDITION?
>> SO EXCELLENT QUESTION.
SO WHAT HAPPENS IS AFTER WE DO THE IMPLANT, YOU GO ON THE BLOOD
THINNING MEDICATION FOR 45 DAYS.
THEN YOU HAVE A REPEAT ULTRASOUND.
IF IT LOOKS GOOD, YOU COME OFF THE MEDICATION, AND YOU STAY ON
TWO OTHER BLOOD THINNING MEDICATIONS, ASPIRIN, AND
ANOTHER, FOR A TOTAL OF SIX MONTHS, AND IF YOU'RE DOING GOOD
THERE, YOU STOP, AND JUST REMAIN ON ASPIRIN.
>> WHAT'S A DRAWBACK FROM THE BLOOD THINNING MEDICATION FOR
PATIENTS?
>> THE BIGGEST DRAWBACK AND REASON WE ARE CONSULTED FOR THE
DEVICE IS BLEEDING.
WITH ANY PROCEDURE OR MEDICATION, THERE'S ALWAYS A
RISK AND BENEFIT.
WHAT I ALWAYS TELL PATIENTS IS AS LONG AS THE BENEFIT OUTWEIGHS
RISK.
THAT'S SOMETHING YOU SHOULD CONSIDER.
SO DOWNSIDE OF BLOOD THINNING IS BLEEDING, AND WE SEE PEOPLE WHO
ARE BLEEDING FROM THEIR STOMACH, BOWELS, OR BRAIN, AND THEY CAN
TAKE MEDICATION, BUT THEY ARE EXPOSED TO THE INCREASED RISK OF
STROKE.
>> OKAY, AND WHO IS NOT ABLE TO HAVE THIS PROCEDURE DONE.
ANYONE WHO MIGHT NOT BE QUALIFIED FOR THE PROCEDURE?
>> EXCELLENT QUESTION.
SO THIS DAY IN 2019, WE'RE NOT GOOD AT IDENTIFYING WHO WILL
HAVE A STROKE AND WHO IS NOT BASED ON JUST HAVING THIS.
SO WE USE A RISK SCORE BASED ON AGE, GENDER, AND CONGESTIVE
HEART FAILURE, ALL THE NUMBERS ADDED UP SO IF YOUR RISK SCORE
IS THREE POINTS OR LESS OR LESS THAN THREE POINTS, YOU SHOULDN'T
GET THIS PROCEDURE.
THE HIGHER THE RISK SCORE, IT SEEMS THE MORE BENEFIT YOU CAN
HAVE.
THE OTHER GROUP THAT MIGHT NOT BENEFIT FROM THIS PROCEDURE IS
ANYBODY WHO HAS AN INFECTION.
YOU DON'T WANT TO IMPLANT A DEVICE IN.
ANYBODY WHO YOU WORRY ABOUT, CONTINUOUS BLEEDING, PUTTING YOU
ON SHORT TERM, BLOOD THINNING REG
REGIMEN, THESE ARE WHO WE ARE CAREFUL ON.
IF SOMEBODY HAS -- IF THE CAUSE IS TYPICALLY DUE TO NARROWING OF
THE VALVES OR REGURGITATION AND SEVERE LEAKAGE, THEY ARE
EXCLUDED FROM THE STUDIES.
>> HOW LONG DOES IT TAKE FOR SOMEBODY TO GO IN AND HAVE THE
PROCEDURE, AND HOW LONG ARE THEY IN THE HOSPITAL.
>> COME IN IN THE MORNING, HAVE THE PROCEDURE, IF EVERYTHING IS
GOING WELL, THEY GO OHM THE NEXT DAY.
>> WOW.
AS A CARDIOLOGIST AND ADVANCEMENTS IN SURGERY, YOU
KNOW, WHERE YOU DON'T HAVE TO DO OPEN HEART, THIS, YOU'VE SEEN,
I'M SURE, SO MUCH THROUGH THE YEARS IN YOUR CAREER, THIS HAS
TO BE EXCITING FOR YOU.
>> NO, IT'S EXCITING BECAUSE WHAT IT DOES IS ALLOW US TO
PROVIDE THERAPY WITHIN OUR OWN COMMUNITY SO BAY STATE ALLOWS
THESE ADVANCED THERAPIES TO BE PROVIDED IN OUR OWN COMMUNITY
WHERE OUR PATIENTS CAN HAVE ACCESS TO THAT EXPERTISE.