One-time Procedure for Atrial Fibrillation Reduces Stroke Risk for a Lifetime
7/29/2020
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A one-time procedure that may reduce stroke risk for a lifetime in people with a specific type of atrial fibrillation (AFib) is now available at Northwest Medical Center-Bentonville. AFib is the most common heart rhythm abnormality in the U.S.; and although AFib is usually not life-threatening, it can lead to other serious problems such as stroke and congestive heart failure.
When a patient has AFib, the electrical impulses that control the heartbeat do not travel in an orderly fashion through the heart. Instead, many impulses begin at the same time and spread through the atria. The fast and chaotic impulses do not give the atria time to contract and/or effectively squeeze blood into the ventricles. Because the left atrial appendage (LAA) is a little pouch, blood collects there and can form clots. In fact, ninety percent of stroke-causing blood clots that come from the heart are formed in the LAA. When those blood clots are pumped out of the heart, they can cause a stroke. People with AFib have a five times greater risk of stroke than those with normal heart rhythms.
The left atrial appendage (LAA) closure procedure is now available to treat patients with non-valvular atrial fibrillation. It works differently from blood thinner medication in that it is a permanent implant that closes off a part of the heart where blood clots commonly form. The implanted device permanently closes off this part of the heart to keep any blood clots that do form from escaping.
Dr. Maria Baldasare, an interventional cardiologist who moved her practice to Bentonville from Kansas in January, said the goal of AFib treatment is to reduce the risk of stroke by controlling the heart’s rate and rhythm. “Stroke is more severe for patients with AFib, as they have a 70% chance of death or permanent disability. To reduce the risk of stroke, physicians usually prescribe medication that thins the blood to prevent blood clots from forming. The most common treatment for stroke risk reduction in patients with AFib is warfarin therapy. Despite its proven efficacy, long-term warfarin therapy is not well-tolerated by some patients and carries a significant risk for bleeding complications. In select patients, physicians may determine that an alternative to blood thinners, most often an LAA closure implant, is needed to reduce AF stroke risk.”
This first-of-its-kind implant, about the size of a quarter and shaped like a jellyfish, is inserted into the heart using a minimally invasive procedure. A flexible tube, or catheter, is inserted through a small incision in a vein in the groin and travels to the left atrial appendage of the heart where the implant is placed. This is a one-time procedure that usually lasts about an hour. Typically, patients are released from the hospital the next day.
In a clinical trial, nine out of ten people were able to stop taking warfarin just 45 days after getting the implant. In addition to minimizing the risk for stroke, the procedure can lower the risk of bleeding associated with the long-term use of blood thinners.
The procedure and implant have been clinically studied for more than 10 years in the US, with more than 100,000 people having received the implant to date.
Dr. Baldasare has earned three board certifications, including internal medicine, cardiovascular disease and interventional cardiology. She received her medical education at Ross University School of Medicine in Portsmouth, Dominica. She completed her internal medicine residency and cardiovascular disease fellowship at Drexel University College of Medicine in Philadelphia, PA. She then completed an interventional cardiology fellowship at Cooper Medical School of Rowan in Camden, NJ, where she was the first female selected for this fellowship program.
About Atrial Fibrillation
Atrial fibrillation (AFib) is a heart condition where the upper chambers of the heart (atrium) beat too fast and with irregular rhythm (fibrillation). AFib is the most common cardiac arrhythmia, currently affecting more than five million Americans. Twenty percent of all strokes occur in patients with AFib, and AFib-related strokes are more frequently fatal and disabling. The most common treatment to reduce stroke risk in patients with AFib is blood-thinning warfarin medication. Despite its proven efficacy, long-term warfarin medication is not well-tolerated by some patients and carries a significant risk for bleeding complications. Nearly half of AFib patients eligible for warfarin are currently untreated for AFib due to tolerance and adherence issues.
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