Dr. Srini Iyengar on the AFib-Stroke Connection

Atrial fibrillation (AFib) is a type of irregular heartbeat that affects an estimated 2.2 million people in the U.S. It’s caused when the heart’s two upper chambers beat rapidly and erratically. According to the American Heart Association, about 15 percent of strokes are a result of untreated AFib.

“When the heart beats too unpredictably or fast, it’s unable to move blood efficiently. Blood pools in the heart, increasing the chance of a blood clot forming, traveling to the brain and causing a stroke. In fact, people with AFib have a five-times greater risk of suffering a stroke,” Boulder Community Health’s structural heart program director Dr. Srinivas Iyengar explained during a free health lecture held on Oct. 2 in Lafayette, Colo.

“Knowing about and properly managing AFib can greatly reduce your risk of stroke,” he added.

What are the Symptoms?
“Often AFib has no obvious symptoms, making it difficult for many people to know they have it,” Dr. Iyengar said. “That's why it's important to get routine checkups, when a doctor can spot any changes to your heart’s rhythm.”

Some people with AFib describe the following:

• Fluttering or fish flopping feeling in their chest
• Frequent palpitations (skipped beats / fast or slow heartbeats)
• Fatigue / lack of energy
• Shortness of breath
• Dizziness
• Chest discomfort

“AFib symptoms can be short lasting or come and go. But anyone with these symptoms should visit a health care provider,” Dr. Iyengar explained.

Stroke Prevention for AFib
According to Dr. Iyengar, blood-thinning medications, such as warfarin (Coumadin®), are the most common treatment for protecting AFib patients from stroke.

“These clot-preventing medications can greatly reduce stroke risk if taken properly and no side effects are seen. Yet, it is estimated that more than half of all AFib patients are not prescribed these medications.” For certain individuals, there are barriers to taking a blood thinner, including:

• dangerous interactions with other medications.
• certain foods that can make the medication less effective (e.g., green leafy vegetables containing vitamin K).
• the need for frequent blood tests and monitoring to ensure a patient is taking the medication safely.
• the concern about excessive bleeding. For example, a blood thinner can cause you to bleed more than usual when you cut yourself. Additionally, people who enjoy an active lifestyle may want to avoid long-term use of blood-thinners because of concerns about bleeding in the event they sustain an injury while pursuing a favorite sport or activity.

Dr. Iyengar stated that newer oral anticoagulants (NOAC) such as dabigatran (Pradaxa®), and rivaroxaban (Xarelto®) do not have dietary restrictions or require routine blood testing, but they’re not for all people with AFib. Plus, they still carry the risk of significant bleeding.

“Current treatments with warfarin or NOACS can be effective, but many patients who do begin them end up stopping because of the many concerns. Studies show that about one in four AFib patients discontinue blood thinners after two years,” he said.

Watchman: An Alternative to Blood Thinners

Your health care provider can help you weigh the pros and cons of taking blood thinning medications. However, as Dr. Iyengar explained, the Watchman procedure could be an alternative for some AFib patients.

“Watchman is a one-time procedure performed under general anesthesia in a catheterization laboratory setting. The procedure usually lasts about an hour and the patient is typically in the hospital for 24 hours following the procedure,” he said. “Afterwards, patients can gradually stop taking blood-thinning medications and enjoy comparable reductions in stroke risk.”

Learn more about Watchman here.

Dr. Srinivas Iyengar is one of Colorado's most experienced Watchman physicians and leads the only team performing Watchman in Boulder County. Call 303-442-2395 to schedule a consultation with Dr. Iyengar.

Click here to view PowerPoint slides from Dr. Iyengar’s lecture on the “Latest Treatments for Irregular Heartbeat.”

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