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Advances in Treating a Cardiac Arrhythmia

New techniques that can prevent strokes in people with irregular heartbeats

Scripps physicians are using a device called the Watchman to prevent stroke in patients with atrial fibrillation.

Most of us aren’t consciously aware of our heart beat until it speeds up due to physical exertion, fear, or excitement. However, for people with a condition known as cardiac arrhythmia, the heart may suddenly start to beat too quickly, too slowly or without a regular rhythm.

“Minor arrhythmias may not require treatment,” says Douglas Gibson, MD, an electrophysiologist at Scripps Clinic. “But the more serious types of arrhythmia may increase the risk of stroke and require medical care.”

The dangers of untreated atrial fibrillation

Atrial fibrillation (AF), the most common type of serious arrhythmia, occurs when the electrical impulses that control the heart become erratic. In a normally beating heart, the two upper chambers (the atria) contract, followed by the two lower chambers (the ventricles) in an organized rhythm.

When the electrical impulses become irregular, they interfere with the atria’s ability to effectively pump blood from the heart. The heartbeat may become very fast, sometimes exceeding 200 beats per minute. Some people experience symptoms, including shortness of breath, fatigue, dizziness or chest discomfort.

Because the heart is not pumping blood effectively, blood can pool and form clots in the upper chambers of the heart. For people with AF, clots are most likely to occur in a part of the left atrium called the left atrial appendage. These blood clots may travel to the brain and cause a stroke. People with AF have a stroke risk that is about 6 times higher than people without atrial fibrillation. About 30 percent of all strokes in the United States are related to atrial fibrillation and they tend to be more disabling than other strokes.

In order to reduce the risk of stroke, many people with AF take medications to thin their blood. Commonly used medications include Warfarin, Eliquis, Xarelto and Pradaxa.

“While medications used to treat AF are effective, they may also have undesirable side effects,” notes Dr. Gibson. “Warfarin, for example, has dietary restrictions and requires frequent blood tests to monitor blood thickness.”

Although blood thinning medications are considered lifesaving therapy because they help to prevent strokes, they all place patients at higher risk for life threatening bleeding.

New procedures for treating arrhythmias

“People who cannot or do not want to take blood thinning medications may be interested in two new procedures, the Watchman and the LARIAT, that may reduce the risk for stroke,” says Dr. Gibson. “These procedures are generally referred to as left atrial appendage occlusion procedures.”

The first procedure involves implanting a tiny, parachute-like device, called the Watchman, into the heart. This device blocks a part of the heart known as the left atrial appendage, which is a small structure in the heart where most blood clots form and is not needed for normal heart function.

The Watchman procedure is minimally invasive and is performed under general anesthesia. Patients usually spend one night in the hospital and can generally discontinue their blood-thinning medications 45 days after the procedure.

“Physicians here at Scripps participated in the research trials that led to the recent FDA approval for this device,” notes Dr. Gibson.

The second procedure, known as the LARIAT, is a similar device that is used to “tie off” or ligate the left atrial appendage. This procedure is also a minimally invasive and is performed under general anesthetic. The LARIAT procedure is currently in clinical trials at Scripps for its ability to prevent strokes in patients with atrial fibrillation with promising results.

To learn more about cardiac arrhythmia treatments that may be right for you, talk to your primary care doctor or a Scripps cardiologist.