Division of Cardiology, Department of Internal Medicine Dr. Ke-Wei Chen
69-year-old Hsu suffered from diabetes, high blood pressure and hyperthyroidism, went to China Medical University Hospital for medical treatment due to sudden palpitation 3 years ago. She was then diagnosed with “paroxysmal atrial fibrillation.” She underwent stroke risk assessment and was suggested to take anticoagulant for treatment over the long run. However, Ms. Hsu has a long medical history of gastrointestinal bleeding and there was concern for triggering more severe hemorrhages through long-term medication. Hence she decided to accept the “left atrial appendage closure” to lower risk for stroke, in addition to increase medication flexibility and reduce the dosage of medication. With the success of the surgery, she has not developed any adverse drug reaction in the past 3 years, which also successfully lowered the likelihood of cerebrovascular accident.
Dr. Wei-Ke Chen of Division of Cardiology, Department of Internal Medicine of CMUH stated that one of the most common causes of cerebrovascular accidents in Taiwan is the arrhythmia of “atrial fibrillation.” Atrial fibrillation is quite common among the elderly group and in certain percentage of young and middle-aged patients. Such arrhythmia occurring in atrium will gradually coagulate blood clot and such blood clot will block the blood vessel when leaving the heart and following the blood to the brain or other organs, resulting in the cerebral infarction of that area, which could not very dangerous.
Dr. Ke-Wei Chen mentioned that even physician from division of cardiology would occasionally measure the pulses to verify if there is atrial fibrillation. The danger of arrhythmia with atrial fibrillation is usually silent and the palpitation perceived by the patient could only be the tip of the iceberg. The public is aware of the hazard of myocardial infarction and pay special attention to the symptoms of chest pain. However, the patients may not be aware when atrial fibrillation evolves from paroxysmal to persistent. “The deadliest disease is the one without pain.” Dr. Chen suggested that if the patient drinks coffee and beverage with strong flavor or add coffee to their drinks, the patient will accidentally discover arrhythmia when receiving health examination in hospital. Such atrial fibrillation is usually persistent upon diagnosis while the patient could be perplexed as they do not usually feel anything.
Dr. Chen indicated that conventional treatment adopts anticoagulant to prevent the formation of blood clot, in order to lower the risk of strokes. However medication could result in inconvenience in life such as adding risk of hemorrhage. Patient may have problem to stop blooding once injured or needs to undergo tooth extraction and other surgery. If the patient forgets to take the medicine or take inadequate dosage, the risk of stroke could increase accordingly. To improve such condition, the current new cardiac catheterization, namely “left atrial appendage closure,” could send the blocker with special design to the left atrium through minimally invasive wound on varicose vein, within a very short period of surgical time. The left atrial responsible for 90% of blood clot for atrial fibrillation is completely closed, which substantially lower the probability of patients having cerebral stroke in the future.
Currently CMUH has executed 134 cases of patients placing “left atrial appendage closure.” Except for one unsuitable case due to the complication of left auricular dextra structure, all other cases have been executed with success. The patients did not develop any adverse complications after the surgery. Therefore, this percutaneous coronary intervention is considered relatively mature and safe, while the length of hospitalization is also short. Patients with atrial fibrillation receiving one permanent surgery may be exempt from long-term and continuous administration of high dosage of anticoagulant, concerns for hemorrhage or inconvenience with medication. Dr. Chen described this surgery as one “good bargain” for treatment.
This surgery comes with restrictions. For example, the aforementioned patients with complicated or large left auricular dextra may not be suitable for placement. The patients are advised to discuss with the surgeons in details before the surgery. Dr. Chen suggested that if patients suffer from frequent palpitation but could not be correctly measured with heart beat using sphygmomanometer, or patients have known arrhythmia, should get examined at the clinic office of Division of Division of Cardiology as early as possible. If the patients are diagnosed with atrial fibrillation, the patients should discuss with the doctors for treatment options such as anti-coagulant and left atrial appendage closure. Patients should also take further examination such as transesophael echocardiography to find the most suitable treatment.