Atrial Fibrillation Impact, causes, risks, Blood thinners. Heart appendance with device implant.

I want to jump in to atrial fibrillation, something that a lot of people may or may not know about this.  It is almost when your heart is out of sync and it is not working well.  Think of it as almost like a seizure of your heart, for the audience to understand.  Typically, you have two beats going on, atrium and ventricle, and they work together in a very synchronous way.  I describe it as two umbrellas that are hooked together by their handles.  The top umbrella is the atria and the bottom is the ventricle.  Normally they beat in a one-to-one partnership and that is what we call normal sinus rhythm.  When you are watching a television show and you see the little blips going blip, blip, blip, blip, blip, blip, you are seeing 1-2, 1-2, 1-2.

Atrial Fibrillation:  The number one cause of atrial fibrillation today is hypertension/stress.  We can talk about stress raising the high blood pressure, but that is how we try and keep your life as low stress as possible.  The top umbrella starts to shake or fibrillate is the term.  Now, instead of going 1-2-3, 60 times a minute, it could be shaking at 3-4-5, 100 times in a minute.  The hallmark that one of your viewers might notice is that they check their pulse in their wrist or their neck rather than feeling bump-bump, bump-bump, bump-bump in a regular pattern; all this said and they feel bump, it is like tap dancing.  It tends to be faster though not always, but it is irregular.  Typically, as soon as you develop this, you become a risk of a stroke. 

If you are in atrial fibrillation for longer than 48 hours, you are at risk of developing a clot in the heart that could break off and travel up to the brain.  The typical person who develops this type of problem is somebody who is diabetic, hypertensive, smoking, overweight, and does not exercise.  Once you need these blood thinners, most people would go on a drug called Coumadin, otherwise known as warfarin. 

We now have a host of new drugs that your viewers will see advertised routinely.  Some of these drugs are like Eliquis, Pradaxa, and Xarelto.  These are all new medicines that do not require monitoring.  The reason why they are going on this anticoagulation is because they can form a blood clot in the heart, the blood clot go to the brain and cause a stroke; so that is why you give them blood thinning.  But there is a big problem with blood thinning medications, right?  The big problem with blood thinning medication, although it works very well in most people, is it there are a number of people who cannot take blood thinners, either they are bleeding from their intestinal tract; they are high risk of falling, they have Parkinson’s or end-stage arthritis; or they elderly and unstable. 

They are variety of different reasons why people cannot take blood thinners.  Ultimately, the problem is that they lead to bleeding.  As a result believe it or not about 50% of people, who should be on a blood thinner to protect themselves against a stroke in atrial fibrillation, are not on a blood thinner.  So, there are now ways of closing the part of the heart where the clots form.  The clots form in an area of the heart called the appendage.  Much like you and I have an appendix in our stomach, we also have an appendix in our heart. 

There is a device called the Watchman, where they take a small umbrella like device, I think your viewers can see it right now; and they position it in the part of the heart, this appendix of the heart, where the clots form.  Over a period of a couple of weeks, this area becomes sealed off much like you had a door to a room in your house that you did not want anybody to know about, so you sealed off the door.  Now that area is no longer available for circulation, therefore no longer available for clots to form, and these people can stop the blood thinners like Coumadin, but still be equally protected against a stroke.  It is a valuable asset now. 

We have been closing the left atrial appendage for years in surgery, but what the Watchman has done is provide us a minimally invasive way much like you were having an angiogram, everything is done through the groin. 

It is about 20 minute procedure, we generally ask you to spend one night in the hospital, you go home the next morning; but the beauty of it is we are providing you with the same protection as a blood thinner, but not exposing you to the risk of bleeding.

I used this in a lot of my older patients, a lot of my patients who are at risk of bleeding either because of an old gastrointestinal bleed.  Some people will tell you I have had an ulcer in my stomach, I have had bleeding in my bowels; lot of reasons people cannot take blood thinners.  I think also a lot of these older patients that are at risk of falling, the fall itself, and also hemorrhagic stroke as a result of these anticoagulation they are at risk; so this is absolutely a revolutionary thing and I did not know anything about it this until you brought it up. 

It is a very minimal invasive procedure, it is done through the groin, and they basically put a plug right at the junction of that appendage or appendix of the heart and basically the blood is not going to be able to get there and form blood clots.  So, is this available now or people are like able to get this procedure done on a routine basis?  Absolutely, it is available all over the country.  The doctors, who are capable of doing it, are trained specially for this.  They can be interventional cardiologists.  A lot of them are electrophysiologists or cardiologists like myself, except the ones that deal specifically with abnormal rhythms of the heart.  My belief is that we are going to see more and more of this technology in the future. 

Nobody wants to take a blood thinner.  Everybody says, “oh! I know that I could bleed now.”  However, we absolutely value their ability to reduce the risk of having a stroke.  People, who have atrial fibrillation and have a stroke, are much more likely to die from the stroke than other strokes, much more likely to be severely disabled for the rest of their lives, and I think having a stroke affects the entire family.  This is something that involves all the family members and affects everybody.  Just for the sake of time and I think you need to recognize the symptoms of stroke, which is called FAST.  Whether there is any facial drooping with arm weakness, you hold your arm if one of them is weaker than the other one.  Slurry speech and time is of an essence because if there is any attack on the brain just like a heart attack, you have a brain attack called a stroke, you want to get to the doctors immediately; time is of an essence and time is braying, and so I think this is tremendous.

I think for people, who have atrial fibrillation if you need for the discussion or questions, Dr. Adam Rosenbluth is always available and send your questions on and I will pass it on to him for any questions when it comes to high blood pressures, diabetes, stroke, and heart attack.  I think it recovered a lot of material.  I wanted to thank you for bringing your knowledge, your expertise, and your personality, which is huge part of your bedside manner and we appreciate you bring here.  Well David, I appreciate the opportunity of being here with you.  You have been such an asset to generations of my practice taking such good care of our patients; but I love way you have distilled the essence of what we talked about today.  I hope that your listeners understand that what we did today through your guidance is provide them with a tool to take better care themselves; absolutely. 

Everything that you have discussed today could impart horrific events, you described it almost as a new form of terrorism in the body and it is; but what you educated your viewers about today are critical opportunities to prevent these things by themselves.  You need the awareness of your doctor to help you understand whether you are at risk, but once you learn this risk please do not be afraid of it. 

Attack it with a veracious appetite, take charge of it, understand that you can be the person that defines better help for yourself.  So, David I cannot thank you enough for letting me come by.  It is a pleasure and I think it is a public service, it is to empower the patients to do something, get their knowledge from here, and pick the doctors around them that could take care of them.  It is a pleasure to have you Adam and I hope we see you more often on this show.  I would be privilege.  Thank you so much for everything that you do.  We will see you again next week, which is Thanksgiving.  We may take the day off, but we will come back, but we will keep you in tune.  Do not eat too much.



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