Srini Iyengar, MD, on treating heart conditions to prevent stroke

Taking care of heart problems can help prevent stroke. For example, atrial fibrillation (AFib) raises a person's risk for stroke by 500%, according to the National Stroke Association. This is because AFib can cause a blood clot leading to stroke. Patent foramen ovale (PFO), an opening between the two upper chambers of the heart, can also cause blood clots.  

Srini Iyengar, MD, interventional cardiologist and director of BCH’s Structural Heart & Valve Program at Boulder Heart, describes minimally invasive, catheter-based procedures for reducing stroke risk from AFib and PFO.  

What is atrial fibrillation? 

AFib is a heart condition that causes the upper chambers of your heart to beat too fast and in a chaotic rhythm. The condition can significantly decrease the heart’s pumping capacity, which increases the risk of clots forming — particularly in the left atrial appendage (LAA), a small sac in the left atrium (the top left heart chamber). 

“More than 90% of stroke-causing clots that come from the heart originate in the LAA,” says Dr. Iyengar. “Approximately 1 in 3 people with AFib will have a stroke in their lifetime. AFib-related strokes are more frequently fatal and disabling.” 

Treatment options  

1. Blood-thinning medications, such as warfarin (Coumadin®), are the most common treatment for preventing AFib-related stroke. These clot-preventing medications can greatly reduce stroke risk, if taken properly and you don’t experience any side effects
   
   “Yet, there are barriers to taking a blood thinner, including dangerous interactions with other medications, dietary restrictions, high prescription costs and concerns about bruising or excessive bleeding from an injury," Dr. Iyengar states. Additionally, their effectiveness varies because of interactions with certain foods and medications, therefore requiring frequent blood tests and dose adjustments. As a result, about 1 in 4 patients discontinue blood thinners after two years. 
   
   When considering blood thinners for AFib treatment, your cardiologist will weigh your risk of a stroke against your risk of a serious bleeding problem. 
    
2. Left atrial appendage closure is an alternative to taking blood thinners. “Closing the LAA, so blood clots can’t form there, is an effective way to reduce stroke risk in people with AFib that’s not caused by heart valve problems,” explains Dr. Iyengar.
   
   To close the LAA, your interventional cardiologist will place a Left Atrial Appendage Closure (LAAC) implant inside the heart through a one-time, minimally invasive procedure. LAAC Implants reduce stroke risk without the worries that come with a lifetime of blood thinners.  

About WATCHMAN  

One LAAC implant is the WATCHMAN Left Atrial Appendage Closure. It is about the size of a quarter and made from very light and compact materials commonly used in many other medical implants. 

The one-time WATCHMAN closure procedure is performed under general anesthesia in a catheterization laboratory for patients with non-valvular AFib (not caused by a heart valve problem) who need an alternative to blood thinners.  

Your interventional cardiologist will insert WATCHMAN through a catheter placed through a small incision in the upper leg, gently guide the implant up through a vein a leg vein, and advance it to the heart, where it permanently seals the opening of the LAA and keeps it from releasing clots. 

The procedure usually lasts about an hour and the patient is typically in the hospital for 24 hours following the procedure.  

In a clinical trial, 96% of people were able to stop taking blood thinners just 45 days after getting the WATCHMAN implant. Learn more about Watchman here. 

Patent Foramen Ovale (PFO) 

PFO is a persistent, flap-like opening between the upper chambers of the heart (the right and left atrium) that did not close the way it should after birth. About 25 to 30% of Americans have a PFO, which can allow clots to go from the right atrium to the left, travel to the brain and cause an ischemic stroke. 

For patients who have experienced a PFO-associated stroke can benefit from PFO closure. This minimally invasive procedure — predominantly for those between the ages of 18 and 60 years —significantly reduces the risk of recurrent stroke. A neurologist and interventional cardiologist will determine whether you’re a candidate for the procedure. 

Your interventional cardiologist will make a small incision and insert a catheter into your groin, guiding it into the heart. Then your doctor will place a little disc, called the Amplatzer™ Talisman™, across your PFO. 

Schedule an Appointment 

Call 303-442-2395 to schedule an appointment with Srini Iyengar, MD, of Boulder Heart. 

View/download lecture slides.

Want to receive notification of special events and lectures? Sign up to receive email notifications.