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The Watchman Device: A Novel Therapy for Prevention of Stroke in Atrial Fibrillation

The LAA occluder being used at Institut Jantung Negara IJN is the WATCHMAN® Device.

Atrial fibrillation AF is an irregular, disorganized, electrical activity of the upper chambers of the heart (atria) resulting in ineffective pumping action of the atria. AF is the most common rhythm disorder affecting over 5 million people worldwide. This ineffective pumping action can cause blood to stagnate or pool in the left atrium, placing patients with AF at a 6-fold increased risk of stroke compared to patients with normal sinus rhythm. Current Practice Guidelines for AF indicate that 15 – 20% of all strokes occur in patients with AF. The rate of embolic stroke among patients with AF averages 5% per year, which is 2 to 7 times the rate for people without AF.

Most strokes associated with AF are thought to be due to migration of blood clots that form in the left atrial appendage (LAA). The LAA is the remnant of the original embryonic left atrium that develops during the third week of gestation. The LAA is about the size of a thumb and usually has an opening about the size of a dime. When the atrium loses its ability to contract in AF, blood pools in the appendage, providing an environment for blood to clot. These clots can then break lose and migrate through the bloodstream and up to the brain causing a stroke.

Treatments are currently available to protect AF patients from stroke or related complications due to blood clots. The most common and effective treatment is the use of the blood thinning medication Warfarin (Coumadin®). Despite its proven efficacy, Warfarin therapy is not well-tolerated by patients, has a narrow therapeutic range and carries a risk for bleeding complications. Additionally, Warfarin may interact with certain foods and medications, thus requiring blood tests and dose adjustments, which can be inconvenient.

The WATCHMAN LAA Closure Technology is a device alternative to Warfarin therapy in patients with non-valvular atrial fibrillation. Patients with AF are at a significantly greater risk of having a stroke due to migration of clots that may form in the LAA. By closing off the LAA, the WATCHMAN Technology is designed to reduce the risk of stroke, cardiovascular death and systemic embolization, potentially eliminating the need for long term Warfarin therapy. The elimination of Warfarin may result in a reduction of bleeding related events such as bruising, nose bleeds, gastrointestinal bleeding, or more importantly, haemorrhagic strokes.

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The WATCHMAN Procedure

The WATCHMAN LAA Closure Device placement procedure is done percutaneously under general anaesthesia in a catheterization laboratory setting. It is done via the right femoral vein and a standard transseptal puncture technique. The procedure usually lasts about an hour and the patient is typically in the hospital for 24 hours following the procedure.

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