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Getting to the Heart of the Matter

Getting to the Heart of the Matter

Inside Warren Knape’s La Habra home, the walls are lined with books. In the living room, a shelving unit overflows with paperbacks and hardcovers. Stacks of work-related reading material sit on his desk.

Warren, 87, lives with his wife Doris in this cozy, sleepy town. A voracious reader, he started a book club at his church after reading The Shack by William P. Young. “I was so impressed with the book that I wanted to share it with people,” he says. Every week, he meets up with a friend to discuss scientific readings. And at the same church, he launched a support and training group for unemployed parishioners.

But Warren’s ongoing work in the community might not have been possible were it not for the care he received in November of 2015 at Keck Medicine of USC. That’s when Rahul Doshi, MD of the USC Electrophysiology Program at Keck Medicine of USC, outfitted Warren with a Watchman device. The device prevents stroke in patients who suffer from atrial fibrillation, which is an irregular heartbeat. It does so without the need for blood thinning medications, which — for people like Warren — can otherwise drastically increase their likelihood of bleeding, including in the brain.

Warren first noticed a problem with his heart about 14 years ago. “It scared me to death,” he says. “I had to go to the hospital.” He was diagnosed with atrial fibrillation, a disease affecting nearly 2.7 million Americans. If left untreated, atrial fibrillation can cause blood clots in the heart that can go to the brain and cause a stroke.

Warren was treated with blood thinners, and on subsequent visits to the hospital, was told simply to rest for several days. But according to Dr. Doshi, certain patients are not good candidates for blood thinners. Those include elderly people over the age of 75, or who have already suffered a brain bleed — both criteria that Warren met.

“Oral anti-coagulants … all involve a risk of bleeding, the most feared of which is intra-cranial hemorrhage, or bleeding in the brain,” says Dr. Doshi. Warren, he adds, was the perfect example of someone who could benefit from the Watchman device. Approved by the FDA in 2015, the device is inserted and plugs the left atrial appendage via a catheter. The append-age is where blood clots in those patients with atrial fibrillation typically occur.

By closing the area off, the patient is far less likely to suffer a stroke from atrial fibrillation without the need for long-term blood thinners.

“Warren is exactly the patient in whom we know we need to decrease the risk of stroke, yet he suffered a bleed around the brain, so we would be very concerned about him being able to tolerate long-term blood thinners,” says Dr. Doshi. “The Watchman is the only device that has a large amount of prospective data that demonstrates at least equivalency compared to oral anticoagulants, so you can mitigate your risk of stroke and without being subjected to the risks of being on an anticoagulant.”

Warren received a call from Dr. Doshi soon after the device was approved, and Warren liked what he heard.

The procedure took about one hour, and was minimally invasive. He went home the same day, and his recovery has been speedy. The device allowed him to come off a medication that caused digestive side effects, and side effects on his thyroid. “I just didn’t like it,” he says of the medication. “It made the heart beat regularly, but it effected the other functions of the body.”

But more importantly, it allowed him to get back to life as usual. “I guess you can tell,” he says, gesturing to the work on his desk, the books next up on his reading list, and his wife in the other room, “that I’m pretty busy.”

by Jessica P. Ogilvie

Keck Medicine of USC is the University of Southern California’s medical enterprise, one of only two university-owned academic medical centers in the Los Angeles area.