WATCHMAN Without Contrast Dye for Patients with Kidney Disease

Heart & Vascular Care
“Often you hear about technology changes coming from elsewhere in the world, not in your backyard.”

Like many people with atrial fibrillation (AFib), Sheldon Kittelson of Clarkfield felt trapped between the fear of having a stroke and the fear of spending a lifetime on blood thinners.

For people with AFib, blood doesn’t flow through the heart normally, which can result in a clot forming in the left atrial appendage (LAA) that can break loose and lead to a stroke. Historically many patients have opted for blood thinners to reduce this risk, but these come with an increased risk of bleeding and can require dietary restrictions and frequent blood tests for monitoring.

Sheldon had been on blood thinners since 2011, and his greatest concern was bleeding. Still active, he farms 1,400 acres of corn, soybean and sugar beets with his sons and is frequently around equipment, which brings increased opportunity for cuts and bruises. “At home, I had Band-Aids all over the place: In my pickup, in my shop, in the bathroom cabinets…everywhere,” said Sheldon.

A life-threating emergency

One day Sheldon’s fears became reality after he suffered a massive intestinal bleed following a colonoscopy. “His medical team struggled to get his bleeding under control, and because they were concerned he could bleed to death during the two-hour ambulance ride, they airlifted him to CentraCare – St. Cloud Hospital,” said his wife Kathy.

Sheldon spent seven days at St. Cloud Hospital while his medical team worked on a repair. Hospitalist Tiffany Rickbeil, MD, decided blood thinners were no longer a practical, long-term solution for Sheldon. However, without them, Sheldon would be at a much greater risk of stroke. Dr. Rickbeil wondered if Sheldon might be a candidate for a WATCHMAN device to reduce the risk. WATCHMAN, a one-time procedural implant, can be placed within the LAA, permanently closing it off and removing the greatest source of clot formation and cause of stroke in patients with AFib. With a WATCHMAN implant, patients no longer require a blood thinner to decrease their risk of stroke, dramatically reducing their risk of bleeding.

To complete a WATCHMAN implant, cardiologists rely on X-ray-based 2D imaging with contrast dye to identify cardiac structures and guide implant of the cardiac device. Unfortunately, contrast dye can be toxic to the kidneys, especially in patients with preexisting kidney disease — and Sheldon has significant kidney dysfunction.

EchoPixel’s ultrasound based 4D hologram technology removes risk of kidney damage

Then Dr. Rickbeil recalled that CentraCare Heart & Vascular Center Cardiologist Jacob Dutcher, MD, had recently conducted the world’s first WATCHMAN device implant utilizing EchoPixel’s ultrasound-based 4D hologram technology, which requires little or no contrast dye.

She called Dr. Dutcher from Sheldon’s room and discussed the possibility of using EchoPixel’s 4D Holographic Therapy Guidance (HTG) technology, which allowed him to see things better than with other ultrasound-based imaging modalities and therefore could potentially avoid contrast dye. Dr. Dutcher believed Sheldon was the perfect candidate to undergo the world’s first ever WATCHMAN implant using EchoPixel 4D HTG as the primary imaging modality without the use of any contrast dye. A few weeks later, the procedure successfully took place.

“About 15% of our patients have significant kidney disease, which eliminates WATCHMAN as an option for them,” said Dr. Dutcher. “Through my work with EchoPixel, I have always envisioned someday being able to expand treatment options to patients like Sheldon, who are not traditionally felt to be good candidates for advanced heart procedures due to issues such as severe kidney disease. I believe EchoPixel’s True3D CT hologram technology, and now live 4D HTG imaging, has tremendous potential going forward.”

The CentraCare Heart & Vascular Center at St. Cloud Hospital has performed more than 500 WATCHMAN implants since 2016 and is recognized as the busiest WATCHMAN implanting center in the five-state area. Dr. Dutcher has now used EchoPixel 4D HTG in nearly 50 patients, including several other procedures without contrast dye.

“EchoPixel’s hologram-based technology has been a game changer,” said Dr. Dutcher, “as it allows me to see a patient’s heart anatomy in a whole new way, essentially replicating the view of a heart surgeon. It’s like being directly inside the patient’s heart, which gives me a better understanding of the 3-dimensional relationship of various structures and devices within the heart.”

Successful procedure improves quality of life

Sheldon hopes his experience can make a difference to others and lead the way for other procedures to be done without contrast dye. He added, “Often you hear about technology changes coming from elsewhere in the world, not in your backyard.”

After the procedure, Sheldon felt great and was able to leave the hospital the same day, and a few days later was back on his tractor, helping his sons with the harvest. He is looking forward to the peace of mind of not having to worry about the risk of stroke or bleeding. And he added, “I hope I don’t have to carry so many Band-Aids in my wallet!”