Dr Smit Srivastava is at DM Cardiology, HOD Cardiology Advancement Cardiac Institute Medical College Raipur
If you have an irregular pulse, experience palpitations, shortness of breath, chest pain, fatigue, and weakness, you could be suffering from a heart disease called atrial fibrillation (AF). Studies have reported AF is a growing epidemic with an expected doubling of its prevalence in India by 2030.
It is a condition that involves irregular beating of the left atrium (upper chamber) of the heart that increases a person’s risk for stroke by four to five times when compared with the people who do not suffer from it. As stroke remains one of the leading causes of death and disability in India, scientists have introduced new methods of evaluating irregular heart beats that have outperformed the approach that has been used conventionally in stroke units.
Therapies like patent foramen ovale (PFO) and left atrial appendage (LAA) closure are performed to close the hole or defect in the heart of patients suffering from cryptogenic & non-valvular atrial fibrillation respectively. The therapies are a breakthrough that could lead to better treatment and outcomes for patients with cryptogenic and non-valvular atrial fibrillation.
Digital innovations are revolutionising healthcare and technology in medicine is paving the way for better treatment. When suffering from this condition, blood clots are most commonly formed in LAA. Closing the LAA is an effective way of reducing stroke risk in people with atrial fibrillation and that is what the new technology does. A nail like device called occluder is implanted inside the heart that permanently closes LAA and keeps blood clots from escaping.
The AF causes 15 to 20 per cent of ischemic strokes, which occur when blood flow to the brain is blocked by a clot or by fatty deposits called plaque. Within a few hours atrial fibrillation there onset of a stroke, treatment with drugs or devices that dissolve or break up the clot, can restore blood flow to the brain and lead to a better recovery. Taking a blood thinner, such as warfarin reduces the risk of stroke in patients with atrial fibrillation.
If you take a blood thinner for AF, you are probably aware of the bleeding risks that come with it. Most people can take blood thinner for years without a risk. But because they help prevent blood clots by thinning the blood, even tiny cuts or bruises will bleed a lot more because of the daily consumption of these drugs. Also, there is a need of getting frequent blood tests done to make sure the patient takes the right amount of medication.
PFO and LAA closure therapies are performed to close the hole or defect in the heart. These procedures do not require open-heart surgery. A permanent device that doesn’t have to be replaced and can’t be seen outside the body is used. To implant the device, the doctor makes a small cut in the upper leg and inserts a needle stick, as done in a standard stent procedure. The doctor then guides the device into the LAA or PFO as per the treatment area. They are done under general anesthesia and take about an hour. Patients stay in the hospital overnight and leave the next day.
LAA and PFO implants have proven to reduce strokes in patients. It can also reduce the risk of bleeding associated with long term use of blood thinners that have been used conventionally.
Stroke is becoming a major cause of death in low-income and middle-income countries like India. To prevent AF and stroke, there should be a focus on early diagnoses, public awareness and capacity building at different levels of health care. It’s important to live a heart-healthy lifestyle — eating a healthy diet, increasing physical activity, avoiding smoking, limiting or avoiding alcohol and reducing stress.