Researchers from UPMC Heart and Vascular Institute in Central Pa. are refining and redefining the optimal treatment for many heart conditions, including atrial fibrillation, or AFib. While the rates of AFib, estimated to affect more than 12 million people by 2030, are increasing, so are the options for care available to patients.
UPMC Heart and Vascular Institute in Central Pa. joined more than 100 hospitals and health systems across the world to evaluate a new treatment option for preventing AFib-related strokes, which are severe and account for about 20% of all strokes.
One clinical trial, which enrolled patients from central Pennsylvania and beyond, was one of the largest efforts to show that a surgical procedure that uses a device to seal a small, finger-like extension of the upper left chamber of the heart called the left atrial appendage can prevent strokes in a broad population of AFib patients.
Dr. Chinmay P. Patel
“More data is needed to demonstrate whether left atrial appendage closure devices can benefit all patients with AFib, instead of the small population of patients it’s currently approved for,” said Dr. Chinmay Patel, cardiologist and electrophysiologist at UPMC Heart and Vascular Institute in Central Pa. “Offering trials like this to our patients advances our knowledge of medicine and can bring promising new treatments and technologies for preventing and treating heart and vascular disease to our region.”
AFib is a quivering or irregular heartbeat that can lead to blood clots, stroke and heart failure. People diagnosed with AFib have five times greater risk of experiencing a stroke than people without AFib because of blood pooling in parts of the upper chambers of the heart. Clots due to pooled blood in the heart’s left atrial appendage account for 90% of strokes in patients with AFib.
In addition to therapies to correct the irregular heartbeat, physicians also prescribe treatments to minimize the risk for stroke. While oral blood thinner medications are good at preventing strokes, the side effects – which include an increased risk for bleeding – can make the medication intolerable for many patients.
“For those individuals, a left atrial appendage closure device provides a possible alternative,” said Dr. Patel. “There is a lot of data to tell us these devices prevent strokes at a similar rate to blood thinners. But unfortunately, this treatment is only available to folks who don’t tolerate the blood thinners. This technology could help even patients who can tolerate blood thinners avoid potentially unpleasant side effects.”
For the clinical trial, Patel and other doctors enrolled patients who could tolerate blood thinners and had recently undergone ablation – a catheter-based procedure that works to correct the abnormal rhythm in AFib patients. To prevent strokes, the participants either remained on blood thinners or underwent left atrial appendage closure procedure with the left atrial appendage closure device. Researchers from across the country, including Patel, followed the patients for three years to see whether they developed strokes, among other health outcomes.
By following the patients’ health outcomes for three years, doctors found that the device was just as effective at preventing strokes and results in less bleeding events than oral blood thinners in AFib patients who can tolerate blood thinners.
Right now, Patel and UPMC in Central Pa. are participating in several other clinical trials evaluating new and existing treatments for AFib.
“In medicine, we need to constantly evaluate whether our current treatments are still the best for our patients,” Patel said. “Where there are gaps in knowledge or a possible better method for treating certain conditions, it’s our responsibility to carefully investigate these questions to give our patients the best care possible.”
Dr. Patel is a paid consultant of Boston Scientific, the manufacturer of the WATCHMAN device used in the clinical trial.
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