Ralph Bish: Atrial Fibrillation

HVI patient Ralph Bish | AFib Patient Story

The Challenge: Atrial Fibrillation and Stroke Prevention

In 1995, Ralph Bish learned he had atrial fibrillation (AFib) — the most common type of irregular heartbeat.

AFib occurs when abnormal electrical signals make the top chambers of the heart — called the atria — quiver instead of beating normally.

In addition to symptoms like heart palpitations, shortness of breath, and fatigue, people with AFib have a higher risk of stroke. This is because their hearts don’t pump as effectively as they should, making it easier for blood to pool and clot.

If a clot breaks loose and moves to the brain, a stroke can happen.

Ralph had a pacemaker implanted to help keep his heart beating in a normal, healthy rhythm. He also started taking a blood thinner to lower his risk of stroke.

Blood thinners work by slowing down the chemical reaction that happens when blood tries to clot. They also can keep clots that have already formed from getting bigger.

While many people can take blood thinners without any trouble, others can form bleeding problems over time.

The Path to UPMC's Center for Atrial Fibrillation

A few years ago, Ralph noticed that routine activities — like climbing stairs — left him feeling weak.

His doctor put him on an exercise program, but Ralph's symptoms didn’t improve.

After a series of tests, Ralph’s doctor found that his blood count was low, and that he had a bleed in his small intestine. Blood transfusions and hospital stays followed, and Ralph began to wonder if he’d ever get back to living a normal, healthy life.

Through his cardiologist — Michael Mathier, MD, head of the Section of Heart Failure and Pulmonary Hypertension at the UPMC Heart and Vascular Institute — Ralph met Raveen Bazaz, MD, an electrophysiologist at UPMC’s Center for Atrial Fibrillation.

Dr. Bazaz has special training on the WATCHMAN, a device for stroke prevention in people with AFib who can't take blood thinners.

UPMC was among a select group of hospitals involved in clinical trials for the WATCHMAN and became the first center in western Pennsylvania to offer the device once it gained FDA approval in 2015.

The Solution: The WATCHMAN Device

The WATCHMAN is a parachute-shaped device that closes off the left atrial appendage (LAA) — the area of the heart most commonly linked to blood clots in people with AFib.

Once doctors implant the device, the body forms a scar around it, safely blocking the LAA. Patients can usually stop taking blood thinners about one month after the implant, once imaging tests confirm the device is working properly.

Dr. Bazaz felt that Ralph was a good candidate for the WATCHMAN.

The device would help Ralph to:

  • Stop taking blood thinners.
  • Get his blood count up.
  • Heal the bleed in his intestines.

Although Ralph was apprehensive of the newly-FDA approved device at first, he thought the WATCHMAN made sense.

“Things were very bleak for me,” Ralph says. “But the WATCHMAN sounded reasonable, and it gave me hope that this could be fixed and I might be able to get back to normal.”

Ralph had a WATCHMAN implant with Dr. Bazaz in November 2015.

During the procedure, Dr. Bazaz made a small puncture in Ralph’s leg and placed a catheter containing the WATCHMAN into his vein. Using special x-ray imaging, Dr. Bazaz guided the catheter into Ralph’s heart and placed the device in his LAA.

Ralph stopped taking blood thinners in December and had follow-up appointments for a few months after the implant.

Today, the 83-year-old retired engineer enjoys life in Freeport, Pa. While physical activity continues to present challenges, Ralph — who worked for NASA early in his career — stays busy with things that let him use his mind and his hands.

“So far, I’m heading in the right direction,” says Ralph. “I hope to improve even further as time goes on.”

Ralph’s treatment and results may not be representative of all similar cases.

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