Baystate Medical Center Offers New A-Fib Procedure | Connecting Point | July 23, 2019


>>>BAY STATE MEDICAL CENTER IS
OFFERING A NEW PROCEDURE, WHICH WILL REDUCE THE STROKE RISK FOR
PEOPLE WITH THE IRREGULAR HEART BEAT CONDITION KNOWN AS A-FIB. I SAT DOWN WITH CARDIOLOGIST
DR. AMIR LOFTI FROM BAY STATE
MEDICAL CENTER WHO EXPLAINED THE PROCEDURE AND BENEFITS.>>A-FIB IS SOMETHING THAT
OCCURS ON THE TOP PART OF THE HEART. YOUR HEART IS TOGETHER. TOP AND BOTTOM FIRE. IN A-FIB, THE TOP PART OF THE
HART HEART BEATS IRREGULARLY AND
FAST, THEREFORE, MAKING THE BOTTOM OF THE FAST BEAT
IRREGULARLY AND FAST. SURPRISINGLY, UP TO 40% TO 50%
OF THE PEOPLE WHO HAVE A-FIB DON’T EVEN FEEL IT. SOME OF THE SYMPTOMS IS CHECKING
THEIR PULSE AND IT’S FAST AND IRREGULAR, FEEL SHORT OF BREATH
WITH ACTIVITY BECAUSE THE HEART RATE SHOOTS UP, COULD HAVE CHEST
PAIN OR LIGHTHEADEDNESS, AND DOWNSTREAM THEY DISCOVERED THEY
HAVE A FIB.>>WHAT CAUSED IT?>>IT IS ONE OF THE MOST COMMON
STATISTICS YOU WILL SEE IS RELATED TO AGE. AS WE GROW OLDER, ONE IN NINE
PEOPLE OVER THE AGE OF 80 CAN HAVE THIS. THAT’S WHY IT BECOMES VERY
COMMON. THE THEORY IS AS THE TOP PART OF
THE HEART OVER TIME, JUST LIKE ANY OTHER PART OF THE BODY, GOES
THROUGH WEAR AND TEAR AND HAS ABNORMAL TISSUE FORMING AND
ELECTRICAL CIRCUIT BEGINS TO GET IMPACTED AND STARTS RANDOMLY
FIRING.>>LIKE A STROKE, FOR EXAMPLE?>>WHEN YOU HAVE AN IRREGULAR
HEART BEAT ON THE TOP WHEN IT’S NOT BEATING IN A REGULAR
FASHION, THERE’S A PART OF THE HEART ON THE TOP LEFT SIDE
CALLED THE LEFT ATRIAL APPENDAGE, A LITTLE FAT THAT
COMES OFF OF IT. THE BLOOD CAN STAGNATE THERE. THE STAGNATION CAN FORM INTO A
CLOTTED. THE CLOT CAN GET DISLODGED AND
CAUSE A STROKE. A-FIB, AS DESCRIBED BECAUSE OF
IRREGULARLY, THE ONE COMPONENT IS THE SYMPTOMS, AND THE OTHER
COMPONENT IS IT SIGNIFICANTLY INCREASES YOUR RISK OF STROKE.>>OKAYMENT CURRENTLY, WHAT’S
THE COMMON WAY TO TREAT THIS?>>SO MEDICATIONS OR SOMETIMES
YOU SEE ELECTROPHYSIOLOGY COLLEAGUES TALK ABOUT MEDICAL
THERAPY FOR THE FAST HEART RATE. FOR THE STROKE PART, YOU TALK
ABOUT MEDICATIONS, AND THERE’S NEWER GENERATION MEDICINES YOU
DON’T HAVE TO CHECK YOUR BLOOD TEST. THAT MEANS A LOT. THAT REDUCES THE CHANCES OF
HAVING STROKE UP TO 70%. SO THAT’S THE MEDICATION ROUTE. NOW, WE HAVE A PROCEDURE ROUTE
IN PEOPLE WHO CAN TAKE LONG TERM BLOOD THINNING MEDICATION, AND
THE DEVICE IS CALLED A WATCHMAN. IT IS A DEVICE THAT LOOKS LIKE A
PARACHUTE OR JELLY FISH THAT FITS INTO THE LITTLE APPENDAGE I
TALKED ABOUT, WHERE THE MOST OF THE TIME THE CLOT FORMS, AND BY
SITTING THERE, YOUR OWN TISSUE GROWS OVER IT AND PREVENTS CLOTS
FROM FORMING THERE.>>AND THIS IS SOMETHING THAT
CAN BE DONE IN THE HOSPITAL, BUT IT’S LAPROSCOPIC PROCEDURE?>>RIGHT. WE GO FROM THE GROIN, FROM THE
VEIN, UP, INTO THE RIGHT SIDE, AND THEN UNDER ULTRASOUND WE GO
WITH THE NEEDLE TO THE LEFT SIDE OF THE HEART, IDENTIFY THE
LITTLE POUCH, MAKE SURE IT’S THE RIGHT SIZE, AND DEPTH AND AT THE
TIME, PICK THE RIGHT DEVICE TO IMPLANT THERE.>>SO THATTISM PLANTS, AND — SO
THAT IMPLANTS, AND HOW LONG DOES IT TAKE FOR YOUR TISSUE TO GROW
OVER IT, AND WHAT DO PATIENTS DO IN THE MEANTIME AS FAR AS
CONTROLLING THEIR CONDITION?>>SO EXCELLENT QUESTION. SO WHAT HAPPENS IS AFTER WE DO
THE IMPLANT, YOU GO ON THE BLOOD THINNING MEDICATION FOR 45 DAYS. THEN YOU HAVE A REPEAT
ULTRASOUND. IF IT LOOKS GOOD, YOU COME OFF
THE MEDICATION, AND YOU STAY ON TWO OTHER BLOOD THINNING
MEDICATIONS, ASPIRIN, AND ANOTHER, FOR A TOTAL OF SIX
MONTHS, AND IF YOU’RE DOING GOOD THERE, YOU STOP, AND JUST REMAIN
ON ASPIRIN.>>WHAT’S A DRAWBACK FROM THE
BLOOD THINNING MEDICATION FOR PATIENTS?>>THE BIGGEST DRAWBACK AND
REASON WE ARE CONSULTED FOR THE DEVICE IS BLEEDING. WITH ANY PROCEDURE OR
MEDICATION, THERE’S ALWAYS A RISK AND BENEFIT. WHAT I ALWAYS TELL PATIENTS IS
AS LONG AS THE BENEFIT OUTWEIGHS RISK. THAT’S SOMETHING YOU SHOULD
CONSIDER. SO DOWNSIDE OF BLOOD THINNING IS
BLEEDING, AND WE SEE PEOPLE WHO ARE BLEEDING FROM THEIR STOMACH,
BOWELS, OR BRAIN, AND THEY CAN TAKE MEDICATION, BUT THEY ARE
EXPOSED TO THE INCREASED RISK OF STROKE.>>OKAY, AND WHO IS NOT ABLE TO
HAVE THIS PROCEDURE DONE. ANYONE WHO MIGHT NOT BE
QUALIFIED FOR THE PROCEDURE?>>EXCELLENT QUESTION. SO THIS DAY IN 2019, WE’RE NOT
GOOD AT IDENTIFYING WHO WILL HAVE A STROKE AND WHO IS NOT
BASED ON JUST HAVING THIS. SO WE USE A RISK SCORE BASED ON
AGE, GENDER, AND CONGESTIVE HEART FAILURE, ALL THE NUMBERS
ADDED UP SO IF YOUR RISK SCORE IS THREE POINTS OR LESS OR LESS
THAN THREE POINTS, YOU SHOULDN’T GET THIS PROCEDURE. THE HIGHER THE RISK SCORE, IT
SEEMS THE MORE BENEFIT YOU CAN HAVE. THE OTHER GROUP THAT MIGHT NOT
BENEFIT FROM THIS PROCEDURE IS ANYBODY WHO HAS AN INFECTION. YOU DON’T WANT TO IMPLANT A
DEVICE IN. ANYBODY WHO YOU WORRY ABOUT,
CONTINUOUS BLEEDING, PUTTING YOU ON SHORT TERM, BLOOD THINNING
REG REGIMEN, THESE ARE WHO WE ARE
CAREFUL ON. IF SOMEBODY HAS — IF THE CAUSE
IS TYPICALLY DUE TO NARROWING OF THE VALVES OR REGURGITATION AND
SEVERE LEAKAGE, THEY ARE EXCLUDED FROM THE STUDIES.>>HOW LONG DOES IT TAKE FOR
SOMEBODY TO GO IN AND HAVE THE PROCEDURE, AND HOW LONG ARE THEY
IN THE HOSPITAL.>>COME IN IN THE MORNING, HAVE
THE PROCEDURE, IF EVERYTHING IS GOING WELL, THEY GO OHM THE NEXT
DAY.>>WOW. AS A CARDIOLOGIST AND
ADVANCEMENTS IN SURGERY, YOU KNOW, WHERE YOU DON’T HAVE TO DO
OPEN HEART, THIS, YOU’VE SEEN, I’M SURE, SO MUCH THROUGH THE
YEARS IN YOUR CAREER, THIS HAS TO BE EXCITING FOR YOU.>>NO, IT’S EXCITING BECAUSE
WHAT IT DOES IS ALLOW US TO PROVIDE THERAPY WITHIN OUR OWN
COMMUNITY SO BAY STATE ALLOWS THESE ADVANCED THERAPIES TO BE
PROVIDED IN OUR OWN COMMUNITY WHERE OUR PATIENTS CAN HAVE
ACCESS TO THAT EXPERTISE.

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