Atrial Fibrillation Management and a Peak Inside the Cath Lab with Dr. Megan Coylewright

Dr. Megan Coylewright, interventional cardiologist, and Danielle Durfey, cath lab RN, sit down with me to talk about atrial fibrillation (AF) management including rate v. rhythm control, anticoagulants, and the Watchman™ device.

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Big Take-Aways

Patients who are in and out of AF (paroxysmal AF) have the SAME chance of having a stroke as patients who are chronically in AF (persistent or long term persistent). From a nursing perspective, once a patient has had AF, and it doesn’t matter if they are still in AF or not, what we really need to concern ourselves with is if our patients are being anti-coagulated and asking why if they are not.
Patients usually remain hemodynamically stable when in AF with rapid ventricular response (RVR), despite the 10-40% drop in cardiac output. Patient’s who will not tolerate being in a fast heart rate and need immediate intervention include patient’s with coronary disease or severe aortic stenosis
1/3 of patients who are prescribed anticoagulants stop taking them after a year

The Watchman™ Device

During AF, blood clots can form in the left atrial appendage (LAA) which is a small sac in the wall of the left atria.

The Watchman™ device is an option for patients who don’t tolerate taking anticoagulants.

The Watchman™ is a LAA closure device that is implanted percutaneously in the cath lab. A catheter sheath is inserted into a vein near the groin and guided into the right atrium, poked through the septum, and into to the opening of the LAA.

Within six weeks of placement, tissue grows over the device, effectively closing off the LAA and preventing blood clots from forming.