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Keeping careful watch on the heart

ALBUQUERQUE, N.M. — A few years ago, U.S. Forest Service volunteer David Hammack fell while hiking his regular route up the La Luz trail and ended up with cactus spines in his head.

After that he started to use hiking poles. If the tumble had come after his doctor put him on a blood thinner because of an irregular heartbeat, it would have been much more calamitous.

Taking the anti-coagulant Warfarin, marketed under the name Coumadin, reduces a patient’s risk for strokes caused by a blood clot reaching the brain. But the side effects can mean lifestyle changes.

Patients must visit their doctor frequently to have their blood checked. They have to watch their diet for foods that can reduce the effectiveness of the medication. And little cuts or bumps can mean serious bleeding or bruising.

Interventional cardiologist Sharif Halim MD and electrophysiologist Hirak Sen MD work on a patient during surgery to insert a Watchman into the left atrial appendage of a patient’s heart. In patients who have irregular heartbeat, known as atrial fibrillation, blood can pool in the appendage and form a clot. If the clot travels to the brain it can cause a stroke. (SOURCE: Presbyterian Healthcare Services)

Hammack, 89, experienced this when a strained upper thigh muscle resulted in an emergency trip to the hospital. Bruising was also a problem for his wife Sondra Hammack, 82, who was taking the same medication because she had suffered a couple of minor strokes.

“It only took the faintest tap and I would have a great big bruise. I had them all over my arms and legs,” Sondra Hammack said.

Those worries are now a thing of the past for the Hammacks. Each of them has undergone a minimally invasive surgery to insert a tiny device into the left atrial appendage of the heart. For patients who have atrial fibrillation – irregular heart rhythm – this is the area where blood can pool and form clots. If a clot escapes and travels to the brain it causes a stroke.

The device made by Boston Scientific is called a Watchman. It was approved by the FDA in 2015. Presbyterian Healthcare Services became the first health system in New Mexico to offer the surgery, in mid-2016. Doctors with Lovelace Health System now also perform the procedure.

After the surgery, if doctors are satisfied after about 45 days that the Watchman is functioning properly, patients can stop taking Coumadin.

The grape-sized device looks like a jellyfish, with a fine plastic mesh cap and a net of tendrils made of nitinol, an elastic metal that can form to whatever shape is needed. Doctors made a tiny incision in the groin area and guide a catheter to the heart where they plant the Watchman at the entrance to the appendage. The medical team tests to see if tiny hooks on the tendrils are firmly lodged. Over time, the surrounding heart tissue will embed it in place. Blood can flow freely through the Watchman’s mesh cap, but clots cannot.

The surgery typically lasts about 30 minutes and patients can go home the next day. David and Sondra Hammack said the only discomfort they recalled was when they had to swallow a probe; before the surgery to check on the condition of the heart, afterwards to see if the device was properly deployed.

Both Hammacks had atrial fibrillation, which puts people at risk for strokes. The condition becomes increasingly common with age. Dr. Sharif Halim, an interventional cardiologist at Presbyterian, estimates that between 10 percent and 15 percent of people over age 65 experience have atrial fibrillation.

Dr. Robert Federici, medical director of The Heart Center at Presbyterian, said the Watchman procedure represents a new direction in medicine. Patients have the option of a one-time procedure which enables them to avoid stroke risks and a lifetime on blood thinning medication with the associated side effects, he said.

“That I no longer have a fear of bruising is a load off my mind,” said David Hammack, “I realized I had to be very careful when hiking not to bang my head because it could have meant a hematoma.”

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