Catheter Ablation vs Common Drugs and Medication
Patients experiencing atrial fibrillation or AFib have a five times higher risk of stroke than those that are not. This increased risk is due, in large part, to pooling and subsequent clotting of blood in the left atrial appendage, or LAA. The LAA is a pouch that protrudes from the left atrium of the heart. As the left atrium begins and continues to malfunction during AFib, the pooling of blood can increase and with it, so does the risk of blood clots. If a clot were to dislodge and enter the blood system, it can travel to the brain and cause a devastating stroke. Strokes from AFib are more likely to be disabling or life-threatening than strokes from other causes.
Medication Therapy
Currently, the primary treatment to help prevent such strokes is the use of anti-coagulant medication such as warfarin. These medications thin the blood and can even break down existing clots. Warfarin and similar drugs can reduce the risk of stroke by up to 66%, however they also come with potential side-effects, some of which can interfere with daily life or present life-threatening issues. Important considerations for blood thinning medication include:
- Significant quality of life issues and side effects of the medication – these can include a wide range of symptoms from persistent headache to joint pain and dizziness
- Complete intolerance to the medication
- Spontaneous bleeding with or without associated trauma
- Continued risk of stroke
- Symptom masking versus treating the underlying condition
- Long-term reduction in effectiveness of the medication requiring a change in regimen or higher dosage
Many patients who come to our office looking to understand more about electrophysiology have never been able to tolerate or have been unwilling to accept the risks of anti-coagulant medication.
Procedural Therapies
The primary benefit of cardiac catheter ablation, as it relates to atrial fibrillation, is that the procedure treats the underlying cause of the arrhythmia. In doing so, we immediately reduce the risk of stroke by regulating the left atrium of the heart appropriately and stemming the pooling of blood in the LAA. However, long-term or untreated atrial fibrillation may have already caused blood to the pool and coagulate within the left atrial appendage. Therefore, new research, including a clinical trial, is evaluating whether the closure of the left atrial appendage can enhance the stroke preventing qualities of cardiac catheter ablation.
Currently, there are two procedures for the closure of the left atrial appendage for patients that are unable to take or are poo long term candidates for anticoagulant medication. These procedure are the LARIAT suturing procedure and the WATCHMAN occlusion device.
Of course, these procedures also come with inherent risks and that will be evaluated and discussed during your consultation. Further, these procedures cannot definitively eliminate the risk of stroke as blood clots can form in other parts of the heart and circulatory system as well. The goal is to reduce the risk of stroke as well as a blood thinner but without the risks of being on a blood thinner long term.
Cardiac ablation, potentially with the addition of the closure of the left atrial appendage, can offer most patients a comprehensive low-risk solution to both their heightened risk of stroke and its underlying cause.
Before stopping the use of any anticoagulant medication, it is important that patients consult with their cardiologist or electrophysiologist to ensure the safety of doing so. As with any medical decision, the benefits must be weighed against the potential risks.
