Fighting Stroke With Medical Technology

Every 40 seconds, someone, somewhere, has a stroke. But with cardiac monitoring, that could all change in a heartbeat.

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Healthy Heart | Mar. 20, 2019

According to the American Heart Association, nearly 800,000 Americans have a stroke each year. And if you're about to have a stroke, your body has probably been warning you for a while. The problem is that these symptoms are often hard to detect.

So, what if something inside your body could give those silent signs a louder voice?

Abbott's tools can help empower physicians to both monitor for and treat conditions that contribute to stroke.

Stroke Prevention Starts in the Heart

Most people think of strokes as a problem with the brain. Sure, while most strokes happen because of a blood clot in the brain, that doesn't really get to the heart of the problem.

After all, that clot likely started somewhere outside of the brain, often in the heart itself. That's what happens in people with atrial fibrillation (AFib), an irregular heartbeat that causes blood to gather and clot in the heart before traveling to the brain.

People with AFib are five times more likely to have a stroke, reports the American Stroke Association — and for them, each time their heart pumps irregularly, it's one of those "warning signs" trying to raise the red flag. Try as we might, humans can't hear it.

But remote cardiac monitoring tools tracking the heart's function from afar can interpret those signs and fire off an alarm that doctors and patients can hear, which has completely changed the game for reducing stroke risk in people with AFib.

Heart Devices to the Rescue

Take Abbott's Confirm Rx™ Insertable Cardiac Monitor, a tiny device that monitors the heart's activity around the clock, syncs up with a smartphone and tracks trouble like a bloodhound.

At about the size of a large paperclip, the Confirm Rx™ ICM wirelessly transmits data, which means your doctor will know if something's wrong as soon as possible. By diagnosing conditions like AFib sooner, physicians can put patients on a path to treatment to help them avoid complications, such as clotting that could increase a person's risk of stroke.

Of course, other types of heart devices can help reduce stroke risk along with cardiac monitoring, too. Abbott's AMPLATZER™ PFO Occluder works to seal up a hole in the heart, called a patent foramen ovale (PFO), which causes blood to leak from one atrium to the other. By sealing up that leak, the tiny mesh device can prevent stroke-causing clots.

Reduce Your Stroke Risk with Better Heart Health

Heart health plays a key role in stroke prevention, so one of the best ways to take care of your brain is to take care of your heart.

Follow these tips to take control of your stroke risk factors — and if they sound familiar, they should! They're also great ways to protect against heart disease, too.

  1. Tackle high blood pressure by eating lots of vegetables, whole grains and fish. Also, watch your salt intake and cut back on foods with high cholesterol.
  2. Manage your weight by watching your calorie intake and exercising at least 30 minutes a day, five times a week.
  3. Notify your doctor of any symptoms of AFib, which can include trouble breathing or heart palpitations. AFib can increase your risk of stroke.
  4. If you have diabetes, manage it with blood sugar monitoring, physical activity, medications and nutrition.
  5. Stop smoking, and avoid tobacco smoke when possible: Even secondhand smoke can raise your stroke risk by up to 30 percent, according to the Centers for Disease Control and Prevention.

Stroke may be a silent killer that attacks every 40 seconds, according to the AHA, but that doesn't mean you can't keep the risk at bay. Ask your doctor for your options, especially if you have AFib.

After all, life should get better with every heartbeat, not worse. Take control of your risk — and know that usually, it starts with the heart.

AMPLATZERTM PFO OCCLUDER IMPORTANT SAFETY INFORMATION

INDICATIONS AND USAGE

The AMPLATZERTM PFO Occluder is indicated for percutaneous transcatheter closure of a patent foramen ovale (PFO) to reduce the risk of recurrent ischemic stroke in patients, predominantly between

the ages of 18 and 60 years, who have had a cryptogenic stroke due to a presumed paradoxical embolism,

as determined by a neurologist and cardiologist following an evaluation to exclude known causes of ischemic stroke.

CONTRAINDICATIONS

• Patients with intra-cardiac mass, vegetation, tumor or thrombus at the intended site of implant, or documented evidence of venous thrombus in the vessels through which access to the PFO is gained.

• Patients whose vasculature, through which access to the PFO is gained, is inadequate to accommodate the appropriate sheath size.

• Patients with anatomy in which the AMPLATZERTM PFO device size required would interfere with other intracardiac or intravascular structures, such as valves or pulmonary veins.

• Patients with other source of right-to-left shunts, including an atrial septal defect and/or fenestrated septum.

• Patients with active endocarditis or other untreated infections.

WARNINGS

• Patients who are at increased risk for venous thromboembolic events should be managed with thromboembolic risk reduction regimen after the PFO Closure following standard of care.

• Do not use this device if the sterile package is open or damaged.

• Prepare for situations that require percutaneous or surgical removal of this device. This includes availability of a surgeon.

• Embolized devices must be removed as they may disrupt critical cardiac functions. Do not remove an embolized occluder through intracardiac structures unless the occluder is fully recaptured inside a catheter or sheath.

• Patients who are allergic to nickel can have an allergic reaction to this device.

• This device should be used only by physicians who are trained in standard transcatheter techniques.

• Transient hemodynamic compromise may be encountered during device placement, which may require fluid replacement or other medications as determined by the physician.

• Do not release the device from the delivery cable

if the device does not conform to its original configuration, or if the device position is unstable or if the device interferes with any adjacent cardiac structure (such as Superior Vena Cava (SVC), Pulmonary Vein (PV), Mitral Valve (MV), Coronary Sinus (CS), aorta (AO)). If the device interferes with an adjacent cardiac structure, recapture the device and redeploy. If still unsatisfactory, recapture the device and either replace with a new device or refer the patient for alternative treatment.

• Ensure there is sufficient distance from the PFO to the aortic root or SVC (typically defined as 9 mm or greater as measured by echo). See Figure 6. and Figure 7.

PRECAUTIONS

• The safety and effectiveness of the AMPLATZERTM PFO Occluder has not been established in

patients (with):

n Age less than 18 years or greater than 60 years because enrollment in the pivotal study (the RESPECT trial) was limited to patients 18 to 60 years old

n A hypercoagulable state including those with a positive test for a anticardiolipin antibody (IgG or IgM), Lupus anticoagulant, beta-2 glycoprotein-1 antibodies, or persistently elevated fasting plasma homocysteine despite medical therapy

n Unable to take antiplatelet therapy

n Atherosclerosis or other arteriopathy of the

intracranial and extracranial vessels associated with a ≥50% luminal stenosis

n Acute or recent (within 6 months) myocardial infarction or unstable angina

n Left ventricular aneurysm or akinesis

n Mitralvalvestenosisorseveremitralregurgita-

tion irrespective of etiology

n Aortic valve stenosis (mean gradient greater than 40 mmHg) or severe aortic valve regurgitation

n Mitral or aortic valve vegetation or prosthesis n Aortic arch plaques protruding greater than 4mm into the aortic lumen

n Left ventricular dilated cardiomyopathy with left ventricular ejection fraction (LVEF) less than 35%

n Chronic, persistent, or paroxysmal atrial fibrillation or atrial flutter

n Uncontrolled hypertension or uncontrolled diabetes mellitus

n Diagnosis of lacunar infarct probably due to intrinsic small vessel as qualifying stroke event

n Arterial dissection as cause of stroke

n Index stroke of poor outcome (modified Ranking score greater than 3)

n Pregnancy at the time of implant n Multi-organ failure

Use on or before the last day of the expiration month that is printed on the product packaging label. 

This device was sterilized with ethylene oxide and is for single use only. Do not reuse or re-sterilize this device. Attempts to re-sterilize this device can cause a malfunction, insufficient sterilization, or harm to the patient. 

The AMPLATZERTM PFO Occluder device consists of a nickel-titanium alloy, which is generally considered safe. However, in vitro testing has demonstrated that nickel is released from this device for a minimum of 60 days. Patients who are allergic to nickel may have an allergic reaction to this device, especially those with a history of metal allergies. Certain allergic reactions can be serious; patients should be instructed to notify their physicians immediately if they suspect they are experiencing an allergic reaction such as difficulty breathing or inflammation of the face or throat. Some patients may also develop an allergy to nickel if this device is implanted. 

Store in a dry place.

Pregnancy – Minimize radiation exposure to the 

fetus and the mother. 

Nursing mothers – There has been no quantitative assessment for the presence of leachables in breast milk. 

ADVERSE EVENTS 

Potential adverse events that may occur during or after a procedure using this device may include, but are not limited to: 

Air embolus Allergic drug reaction; Allergic dye reaction; Allergic metal reaction: Nitinol (nickel, titanium), platinum/iridium, stainless steel (chromium, iron, manganese, molybdenum, nickel); Anesthesia reactions; Apnea; Arrhythmia; Bacterial 

endocarditis; Bleeding ; Brachial plexus injury; Cardiac perforation; Cardiac tamponade; Cardiac thrombus; Chest pain; Device embolization; Device erosion; Deep vein thrombosis; Death; Endocarditis; Esophagus injury; Fever; Headache/migraine; Hypertension/hypotension; Myocardial infarction; Pacemaker placement secondary to PFO device closure; Palpitations; Pericardial effusion; Pericardial tamponade; Pericarditis; Peripheral embolism; Pleural effusion; Pulmonary embolism; Reintervention for residual shunt/device removal; Sepsis; Stroke; Transient ischemic attack; Thrombus; Valvular regurgitation; Vascular access site injury; 

Vessel perforation 

RX ONLY

INDICATIONS:

The Confirm Rx™ ICM is indicated for the monitoring and diagnostic evaluation of patients who experience unexplained symptoms such as: dizziness, palpitations, chest pain, syncope, and shortness of breath, as well as patients who are at risk for cardiac arrhythmias. It is also indicated for patients who have been previously diagnosed with atrial fibrillation or who are susceptible to developing atrial fibrillation. The Confirm Rx™ ICM has not been specifically tested for pediatric use.

CONTRAINDICATIONS:

There are no known contraindications for the insertion of the Confirm Rx™ ICM. However, the patient’s particular medical condition may dictate whether or not a subcutaneous, chronically inserted device can be tolerated.

ADVERSE EVENTS:

Possible adverse events (in alphabetical order) associated with the device, include the following: Allergic reaction, Bleeding, Chronic nerve damage, Erosion, Excessive fibrotic tissue growth, Extrusion, Formation of hematomas or cysts, Infection, Keloid formation and Migration. Refer to the User’s Manual for detailed indications, contraindications, warnings, precautions and potential adverse events.

ADDITIONAL INFORMATION:

Clinicians must log onto Merlin.net™ Patient Care Network to view transmissions from patients’ Confirm Rx™ ICM. On Merlin.net™ PCN they can configure transmission schedules and enable or disable features on a patient’s myMerlin™ for Confirm Rx™ ICM mobile app. Review of transmissions is dependent on the clinician and may not happen immediately following delivery of such transmissions.

LIMITATIONS:

Patients may use their own Apple‡ or Android‡ mobile device to transmit information from their Confirm Rx™ ICM using the myMerlin™ for Confirm Rx™ mobile app. To do so the device must be powered on, app must be installed, Bluetooth® wireless technology enabled and data coverage (cellular or WiFi‡) available. The myMerlin™ for Confirm Rx™ mobile app provides periodic patient monitoring based on clinician configured settings. Data is resent if the transmission was not sent successfully. However, there are many internal and external factors that can hinder, delay, or prevent acquisition and delivery of ICM and patient information as intended by the clinician. These factors include: patient environment, data services, mobile device operating system and settings, ICM memory capacity, clinic environment, schedule/configuration changes, or data processing.

An Abbott mobile transmitter is available for patients without their own compatible mobile device.