This latest technology is being pioneered at Leeds Teaching Hospitals NHS Trust.
Leeds is one of only a few national centres that has been chosen by the NHS to evaluate left atrial appendage occlusion (LAAO) treatment for the rest of England.
Along with the other centres, the hospital is implanting the Watchman device, which helps prevent strokes for patients suffering an irregular heartbeat (atrial fibrillation) by sealing off the small pocket-like structure (left atrial appendage) in the heart where the vast majority of clots form.
Evelyn Kendell, 80, from Armthorpe near Doncaster, was one of the first to benefit from the device. After suffering from atrial fibrillation she was prescribed Warfarin, a widely used anti-coagulant which can have other negative side-effects, and suffered a brain haemorrhage which was attributed to its use. Advised against using such medication in future, consultants recommended the implantation of the Watchman in August 2014.
Mrs Kendell, an arts enthusiast who has studied at the University of the Third Age (U3A) which provides qualifications for retired people, has illustrated children’s books and helped with the gold leaf renovation of Doncaster Minster, said:
“I’ve always been active physically and mentally, and I engage in a lot of local community activities, so suffering from an irregular heartbeat and having the risk of stroke hanging over me was quite traumatising. I was no longer able to use Warfarin and felt very vulnerable but was recommended the Watchman by a consultant, and was lucky that it was available at Leeds Hospital. Since then I’ve been able to get back to life as normal with peace of mind. Whilst the Watchman can’t resolve my irregular heartbeat, I feel safer knowing that I now have a much lower risk of stroke and other complications that clots can cause.”
The Watchman device is not routinely available on the NHS until the evidence base can demonstrate sufficient clinical and cost-effectiveness. However it is to be made available in 10 centres of excellence like Leeds through a system of Evaluation through Commissioning. The NHS will not only gather evidence through this project on effectiveness as a treatment, but also the cost-effectiveness of the strategy. The NHS will allow the treatment to a limited number of devices and patients and evaluate the outcomes to determine if the device should be made available routinely in the future.
The Watchman device works by closing off the left atrial appendage and helps to prevent blood clots forming in this part of the heart which can cause a stroke. Once implanted, the Watchman device (pictured) prevents potential future clots and never needs to be replaced. After several months the device is actually incorporated into the heart’s wall, and sealed in by the patient’s own tissue. The device has been shown in a large randomised controlled trial to be at least as effective as warfarin, meaning that for stroke prevention there is now a real alternative to taking a daily drug.
An Office of Health Economics study in 2009 estimated that atrial fibrillation led to an estimated 851,095 GP visits, 575,000 hospital admissions and 5.7 million bed days in 2008, and the cost to the NHS is in excess of £1.8 billion.
Dr Lee Graham, Consultant Cardiologist & Electrophysiologist performing LAAO at Leeds Teaching Hospitals, said:
“LAAO devices such as the Watchman are a major step forward as a potential alternative to anti-coagulants like Warfarin, especially in certain patients who are at high risk of stroke but cannot take such medication because of a high perceived bleeding risk. We’re very pleased to be one of the centres offering this device as part of the evaluation process.”