Floridians’ hearts go aflutter more than anywhere else in the country – not because we fall in love more often or experience more delight, but because the counties with the highest cardiac dysrhythmia hospitalization rates are in the state, according to the Centers for Disease Control.
While that strange and not so fun fact isn’t much use to most of us, it does require Florida cardiologists to become most proficient at regulating irregular heartbeats and mitigating the consequences of arrhythmia.
Atrial fibrillation (AFib) is the most common type of heart arrhythmia. When a person has AFib, the heart beats too slowly, too fast or in an irregular way because the upper and lower chambers of the heart are out of sync and blood doesn’t flow normally. This can cause blood to pool in an area of the heart called the left atrial appendage (LAA). There, the blood cells can stick together and form a clot. If the clot breaks loose, it can cut off the blood supply to the brain, causing a stroke.
Dr. Carlos Gonzalez Lengua, an interventional cardiologist with Cleveland Clinic Indian River Hospital, said “96 percent of blood clots that form in the heart come from a small area called the left atrial appendage.
“The appendage is like an appendix that you have in your belly. It’s a little pocket that unfortunately doesn’t have a lot of functions, but it does collect blood where it can clot. To prevent strokes, we generally give AFib patients blood thinners to keep the blood flow moving.
“Unfortunately, some people don’t tolerate blood thinners because they have bleeding issues. So, they stop the blood thinner, which in turn increases their risk of stroke. For these patients we now have a permanent solution to blocking the flow of blood into the LAA. It’s called the WATCHMAN Implant.
“The WATCHMAN implant permanently reduces your risk of stroke. It fits right into your LAA and permanently closes it off to prevent blood from pooling there. It’s a safe and minimally invasive procedure and doesn’t require open heart surgery.”
The WATCHMAN device is about the size of a quarter, although it can range from about 20 to 40 millimeters, enabling the implant to fit a greater number of patients. It’s placed into your heart in a one-time procedure. The procedure is done under general anesthesia and patients commonly stay in the hospital for a day or less.
To implant the WATCHMAN, your doctor makes a small cut in your upper leg and inserts a narrow tube. He then guides the WATCHMAN Implant through the tube into the left atrial appendage of your heart. Over time, the heart’s tissue grows over the implant until the LAA is permanently sealed off.
“The procedure is relatively easy,” Dr. Gonzales-Lengua said. “Under X-ray and echocardiography guidance, we go through a vein in the groin on the right side into the right atrium, which is the upper chamber, and we create a little hole in the wall of the heart that we pass through the right atrium to the left atrium where the appendage is. Then we implant the device and plug the appendage.
“Once the device is implanted, it’s recommended by the FDA that we check it after 45 days to make sure that it’s in the same place and there’s no blood clots around the device or any other unusual issues with the implant,” Dr. Gonzalez Lengua continued. “We generally keep the patient on blood thinners for that 45-day period but if everything checks out, we stop the medication. About 96 percent of our patients come off blood thinners completely within 45 days after the implant.”
Not everyone is a candidate for the WATCHMAN Implant. The decision is generally made between the cardiologist, the primary care doctor and the patient.
Patients are likely candidates for the procedure if they have bleeding from blood thinners, can’t afford their medications or are not complying with medication. The doctors will discuss the pros and cons of the WATCHMAN and then submit a request to the patient’s insurance company to get it approved.
“If a patient has AFib and is on blood thinners with no bleeding issues, then maybe the procedure isn’t for you,” Dr. Gonzalez Lengua said. “If you have AFib and are not high risk to have a stroke, meaning you are not on blood thinners, then you don’t need the procedure.
You need to talk to your cardiologist about whether the procedure is for you.
“The WATCHMAN device decreases your risk of stroke by the same percentages that blood thinners do. It doesn’t cure AFib, but it regulates it without medication. It’s a very popular procedure because it eliminates any issues that come with taking blood thinners and it protects you against stroke for the rest of your life.”
AFib is a serious condition that affects up to 6 million Americans annually, and death rates primarily attributed to AFib have been rising for more than two decades.
According to the American Heart Association, if you have AFib you are five times more likely to have a stroke than someone who doesn’t have it. If you are experiencing symptoms such as chest discomfort, irregular heartbeats, exhaustion and dizziness, it’s recommended you see a healthcare professional as soon as possible.
So why does Florida have the highest concentration of AFib in the nation? It’s probably simple demographics. The chance of developing AFib increases with age, with about 70 percent of AFib patients being between the ages of 65 and 85. Since retirees have long flocked to the Sunshine State, their high proportion of the population equates to more incidences of AFib.
Dr. Carlos Gonzalez Lengua received his medical education at Universidad Nacional de Colombia in Bogota, Columbia, and served his residency at Lincoln Medical and mental Health Center in Bronx, N.Y. He completed fellowships in cardiovascular imaging and interventional cardiology at Icahn School of Medicine at Mount Sinai, N.Y., and in structural heart disease at New York School of Medicine. His office is located in the Rosner Family Health and Wellness Center, 3450 11th Court, Vero Beach. Call 772-563-4690 for an appointment.
