Friday, December 22, 2006

Update on Atrial Fibrillation

Probably the most common arrhythmia in the elderly is atrial fibrillation. Whereas less than 1% below 60yrs have atrial fibrillation (AF for short), it affects 4% of males above 60yrs and >10% of males above 80yrs. It can cause a 25% or more drop in cardiac output and what is even worse is that it is resposible for up to 25% of all stokes, especially in the elderly. Stroke is a very devastating illness as it cause severe debility and can cause an active person to suddenly become totally dependent and obviously increases cost of care. It drives up healthcare cost.

We will deal with management of AF another day.

Clinical studies have shown that most often, the source of the stroke causing emboli arises from the left atrial appendage. The standard treatment for stroke prevention was warfarin anti-coagulation, with all its attendant risk and side-effects. Surgical bending of the left atrial appendage was another treatment modality for stroke prevention in atrial fibrillation especially in patients who could not take warfarin. Currently, the cardiologist in William Beaumont Hospital, Royal Oak Michigan, is working with AtriTech on the Watchman device to occlude the left atrial appendage and prevention left atrial appendage thrombus formation and so prevents stroke.The beautiful thing about the Watchman Device is that it can be introduce percutaneously via the femoral veins, thus avoiding cardiac surgery.

Perhaps this will allow us to prevent strokes in patients with chronic AF. Oh yes, we have not mention cost. I am sure that it will not be cheap. Anyway, good things are seldom cheap, especially in healthcare.

No comments: