Dr. Ken Stein, senior vice president and chief medical officer for Rhythm Management and Global Health Policy at Boston Scientific, has dedicated much of his career to improving the quality of life for patients with atrial fibrillation (AFib), the most common type heart rhythm disorder.
After 31 years of experience, both treating patients and developing medical devices to help manage the disease, Dr. Stein gained a new perspective when he was diagnosed with AFib in 2018.
In recognition of AFib Awareness Month this September, we sat down with Dr. Stein to gather his insights – as both a physician and patient – on navigating an often-challenging AFib journey.
Q: Why is it important to raise awareness of AFib?
A: AFib affects more than 33 million patients worldwide. Any person, regardless of age and physical fitness, can develop AFib, so it’s important to know the signs and how to talk to your doctor for a proper diagnosis. We also know that the likelihood of AFib increases with age and many predict the number of AFib cases will continue to rise rapidly over the next few years, increasing the importance of broader awareness.
AFib also increases the risks of heart-related death and stroke, though many patients still do not fully recognize the potentially serious consequences. About one in seven strokes are caused by AFib and strokes caused by complications from AFib tend to be more severe than strokes with other underlying causes.
Part of the reason I am open to sharing my personal journey with AFib is because I have addressed the condition from many sides – doctor, medical device manufacturer and now a patient – and I hope my experiences can help others better understand their diagnosis and manage their AFib in way that suits their individual needs.
Q. Can you tell us more about your personal experience?
A. My first episode happened during a routine bike ride – something I often do to unwind. I noticed my heart rate had spiked and that it wasn’t coming down. I remember thinking, “at what point do I go to the hospital?” After about an hour, it returned to normal, but by then I knew what I was facing.
Experiencing A Fib as a patient gave me a new appreciation for how life-altering the diagnosis can be. The first thing many patients try to do is identify what may trigger an episode. Because of my background, I knew the common triggers and began cutting them out. No alcohol, no caffeine, no rigorous physical activity, getting plenty of rest, but the episodes kept happening. Perhaps even worse than going through an arrhythmia is the fear of not knowing when the next one is coming and not understanding the cause.
I tried a few different medications to prevent the episodes, and when those didn’t work for me, I opted to have an ablation procedure, which helps prevent abnormal electrical signals from moving through the heart. In order to have the ablation, I was placed on a blood thinner (to lower the risk of experiencing a stroke from the procedure) for a few months.
Q. Did you have reservations about using a blood thinner?
A. Blood thinning medications, or anti-coagulants, can save lives because they can treat or prevent dangerous blood clots that can lead to stroke. However, in doing so, patients can experience unwanted and sometimes dangerous bleeding. As someone who enjoys skiing in the winter and cycling in the spring and summer, I feared that using blood thinners would prevent me from doing the activities I have always enjoyed because of the risk of falling and experiencing trauma.
Although my AFib was treated via an ablation procedure, I still needed to use blood thinning medication for three months around the time of the procedure. I decided to start the course of medicine between ski trips and some other activities I had planned.
Looking back, it’s a good thing I did as a few months after my procedure I was involved in a fairly serious biking accident that conceivably could have been fatal had I still been using blood thinners.
Q. What advice would you offer someone who is considering different options to manage AFib?
A. First, talk to your doctor. Decision making around AFib can be complicated and the more a patient understands their condition, the better decisions they can make about treatment plans.
There are two main goals in treating AFib, the first being rhythm control, avoiding symptoms and improving or avoiding heart failure. The second being stroke avoidance. Each of these goals may involve different treatments and it’s important to work with your doctor to fully understand your options.
This open dialogue also allows your doctor to consider your lifestyle and personal priorities when recommending a treatment. Even in my case where I knew a lot about AFib, my doctor really helped me think through the options.
Also, do some of your own research and consult with patient advocates. There are many educational resources available, such as www.StopAFib.org, to inform and empower your decisions.
Q. What does the future hold in terms of AFib management options for patients, and what are you most excited about?
A. For stroke prevention, I am excited about the progress we are making for patients who need an alternative to blood thinners as a treatment. Recently, the FDA approved our next-generation WATCHMAN FLXTM Left Atrial Appendage Closure Device. The one-time implant permanently closes off an area of the heart where blood clots commonly form, reducing the risk of stroke without the use of blood thinners.
Another exciting development is the upcoming CHAMPION AF trial, which, for the first time, compares the WATCHMAN FLX device with non-vitamin K antagonist oral anticoagulants - considered the most contemporary blood thinners available. We believe the CHAMPION trial will help answer the question of whether the WATCHMAN FLX device should be offered as a first choice to patients with a high-risk of stroke, rather than an option to only those patients who have a medical reason to avoid blood thinners.
In terms of rhythm control, there have been great advancements in ablation technologies such as pulsed field ablation (PFA). This procedure ablates heart tissue with a therapeutic electric field instead of using more common thermal energy sources such as radiofrequency ablation or cryoablation, and is designed to spare nearby tissue from unintentional ablation. We are excited about our internal PFA development projects as well as our recently expanded investment in this emerging technology.
Also promising within the realm of ablation advancements are the recent CE Mark approvals for the POLARx™ Cryoablation System and the INTELLANAV STABLEPOINT™ Ablation Catheter enabled with DIRECTSENSE™ Technology. These innovative devices are well-aligned with our category leadership strategy of providing meaningful tools and solutions to electrophysiologists so they can select a therapeutic option based on clinical preference and individualized patient needs.
As a physician and a patient, I can appreciate how improved technologies and more information about treatment options can make living with AFib less challenging.
To hear from more patients about their experience with non-valvular AFib and treatment with the WATCHMAN TM Left Atrial Appendage Closure Device, click here. And, to learn more about our comprehensive portfolio of ablation products, click here.