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Is There A Better Way to Treat Atrial Fibrillation?
 

Atrial fibrillation (in short, AF or afib) is a heart disease that occurs when the upper chambers of the heart quiver instead of beating properly. This would let the blood to pool in a pouch-like appendage. Clots could then form and travel to the brain, causing stroke to occur. More than 2 million Americans are suffering such disorder.

AF is usually be identified by taking a pulse and observing that the heartbeats do not occur at regular intervals. A more accurate indication of AF is the absence of P waves on an electrocardiogram (ECG or EKG). P waves are normally present when there is coordinated atrial contraction at the beginning of each heartbeat. Risk of AF increases with age. There are 8% of people, who are above the age of 80, have AF.

Warfarin, an anti-clog drug, is usually used to treat AF, but getting the right dose is never an easy task. Too little warfarin might raise the risk of stroke and too much of it can cause fatal bleeding. The optimized amount does vary from one person to another. Therefore, doctors need to monitor the dose for their patients through regular blood test.

While doctors and patients are hoping for a better choice, an experimental device that is considered as a safe and effective alternative to warfarin emerges. The new device is called ‘Watchman’, and it aims to permanently fix AF. The announcement of the findings at the American College of Cardiology (ACC) 2009 annual meeting on March 28, 2009 had impressed many doctors and health professionals.

Watchman, which has nothing to do with the movie “WATCHMEN”, is a fabric-covered metal cage that plugs the pouch. Doctors need to pass a hollow tube through the leg vein into the right atrium of the patient’s heart, and puncture the wall separating it from the left atrium. The device is then implanted through the tube.

707 patients in the United States and Europe were involved in a study of Watchman by the researchers from the Mayo Clinic in Rochester, Minnesota. 463 patients were implanted with Watchman while 244 patients were prescribed with warfarin.

After an average of 16 months of follow-up, 15 strokes and 17 deaths (from all causes) were found in the Watchman group and 11 strokes and 15 deaths were recorded in the warfarin group. The results showed that the Watchman group performed much better with about 3 percent of the Watchman patients suffered the main problems against the 5 percent of those in the warfarin group. The main problems, as measured by the doctors in the trial, were a composite of strokes, heart-related deaths and certain blood clots. Meanwhile, the finding also showed that about 90 percent of device patients were able to go off warfarin.

However, complications and problems did occur. There were 5 strokes triggered by implanting the device and about 5 percent of the device patients developed serious fluid buildup around the heart. Meanwhile, the doctors were unable to implant the device in 41 people who were initially assigned to get it. But as pointed out by the researchers, these problems declined as the study went on.

When the device is approved, patients and their doctors might have to decide if they wish to assume certain increased risk at the outset or prefer to adopt the ongoing therapy with warfarin, where there is a small risk of complications that is cumulative.

But for the 75-year-old patient who participated in the trial, implanting the device was an easy choice. He dislike taking drug and found it a horrible experience for him.

Having been on Coumadin (warfarin) for about 2 years, he had the device implanted during March 2008 as part of the study. He always found difficulty to regulate, and so doctors were constantly adjusting the dosage for him. Meanwhile, he had to go for blood test sometimes as often as 3 times a week. He admitted he would do anything to get off of the Coumadin.

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