January 2021 Health Matters

WATCHMAN™ | One Procedure. Lasting Results. For patients with an irregular heartbeat, known as Atrial Fibrillation or Afib, who cannot tolerate blood thinners such as Coumadin (Warfarin) or the newer anticoagulants, such as Eliquis, Xarelto, or Pradaxa; a new device called the WATCHMAN may help reduce your risk of stroke. The WATCHMAN device implantation is not exactly new. In fact, it is one of the most studied devices on the market. More than 100,000 WATCHMAN procedures have been performed worldwide and have over ten years of U.S. clinical studies behind it. The WATCHMAN device is the only FDA-approved implant proven to safely and effectively lower stroke risk in people with Afib not caused by heart valve problems. People with Afib are five times more likely to suffer a stroke than people with a regular heart rhythm. This is because when you have atrial fibrillation, the top parts of the heart (called the atria) tend to quiver and not beat regularly. The blood tends to stay stagnant and pool inside of a small pouch in the heart (called the left atrial appendage). When that blood goes into that left atrial appendage, it can sit there and form a blood clot, which can then travel up to your brain, causing a stroke. Statistics show that 90% of the devastating, debilitating strokes that occur are caused by a clot that has formed inside the left atrial appendage. The WATCHMAN device is implanted into the left atrial appendage, and after about six weeks, your heart forms a tissue barrier over the device so no clots can escape. A special echocardiogram is performed at that time to assess the device. An article published in the Journal of the American Medical Association determined the WATCHMAN offered a longer life expectancy than Coumadin use. Some patients cannot tolerate being on blood thinners because they may develop bleeding risks, especially if they are on other blood thinners. The procedure is performed by placing a catheter through the femoral vein in the groin to get to the heart’s left side. Patients will be under general anesthesia during the procedure. The shape of the appendage is different for everybody, and that will be determined during the initial evaluation because successfully implanting a device is very anatomy dependent. The device comes in five sizes, and your doctor will match the best sized device for your appendage size and shape. The procedure takes approximately 90 minutes and includes an overnight stay in the hospital. Patients will follow up with Vanessa Russino, ARNP-BC, structural heart coordinator, one week after the procedure and will be scheduled for a six-week follow-up transesophageal echocardiogram (TEE) to assess the device and appendage. Studies have shown that 96% of patients are able to come off blood thinners after 45 days. Some patients ultimately are not candidates for the WATCHMAN procedure due to their left atrial appendage anatomy or if they are unable to tolerate anticoagulants in the short term.

For information or to make an appointment, call (239) 624-4274 .

A Leadless Pacemaker Sets a New Pace for Some Cardiac Patients at NCH By Jean Amodea There is a new kind of pacemaker setting heartbeats – and NCH has the distinction of being the second healthcare provider in the nation and the first in Florida to perform the open surgical implantation of the leadless pacemaker. Pacemakers are used to treat heart arrhythmias – or a faulty heartbeat. Whether too fast or too slow, heart arrhythmias are very common, affecting more than 3 million Americans each year. Pacemakers are small implantable devices that send out electrical signals that help keep the heart beating properly. Traditional pacemaker generators are implanted into the shoulder with wire leads and electrodes running from the pacemaker into the heart. The generator sends an impulse through the leads into the heart to regulate the heartbeat.

The all-new leadless pacemakers are tiny and self-contained, thus eliminating the need for a traditional generator and leads, explained NCH Cardiothoracic Surgeon Brian Solomon, M.D., F.A.C.S. “Leadless pacemakers do not have wires, so blood clots are avoided,” he said, “and they are not able to be fractured, like traditional pacemakers.” Although both types of pacemakers can be monitored remotely, the leadless version is also remotely programmable by the physician, eliminating the need to reoperate for re-programming and re- insertion, which is required for adjustments with traditional pacemakers. “With the leadless, it is easily adjusted, and heart rhythms are better managed after surgery,” explained Dr. Solomon, who was the first surgeon to perform the leadless pacemaker implantation at NCH. Recently, a patient undergoing open-heart surgery avoided the installation of a complex mechanical system screwed onto the outside of the heart by having the leadless pacemaker implanted into the heart instead. “Surgically inserting (the pacemaker) prevented the risk of infection, blood clots, an extra incision, and a longer hospital stay to manage the rhythm, thus saving the patient from future complications,” explained Dr. Solomon. “In this case, we could literally look into the heart and see exactly where it needed to go. The leadless pacemaker hooks into the septum (the wall dividing the heart’s chambers) and stays there. So, we took the same delivery system and implanted it directly into the heart, rather than having to make a separate incision either through the groin or through the chest to implant.”

In the last two years, 77 leadless pacemakers have been implanted at NCH with a success rate of more than 99 percent. For more information, call NCH Heart Institute at (239) 624-4200 .

Leadless pacemakers

• More easily regulates heart rhythm, post-surgery • Does not require a separate incision • Leaves no scar or bump in the chest • Batteries do not need removal as they last approximately ten years • A new battery can be implanted next to it through the groin without making an incision

• Usually implanted by electrophysiologist through an incision in the groin • Bullet-sized, about 2 cm x ½ cm, and self-contained • Requir es shorter hospital stays • No wires are running through the chest that may cause blood clots • Easily reprogrammable in office – no need to reoperate • Provides easy adjustments through sensors in a remote control


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