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success since risk otherwise accumulates with time. "Ideally, we want to evaluate patients before they have a major bleeding prob- lem," Dr. A hmed says. " Patients who receive the Watchman typically have to ta ke blood thinners for six weeks after impla ntation, so we wa nt to impla nt the device before bleeding issues arise. Once these high risk patients do bleed, it is often too late for the procedure." D r s . A h m e d a n d A n g h e l a s s e s s pat ient s ' el i g ibi l it y for Wat ch m a n based on well-published, peer reviewed ca lcu lat ion s of t hei r r i sk of s t roke and bleeding, as well as the results of a t ra nsesopha gea l echoca rd iog ra m (TEE). Patients receive genera l anes- thesia for the implantation procedure, which ta kes an average of 75 minutes. The Heart Group performs Watchman pr o c e du r e s a t Up s t a t e Un iv er s it y Hospita l and will soon begin doing so at St. Joseph's Hospita l. " To place t he Watchma n, we ga in access to the veins that converge en route to the right side of the heart via a sma ll incision in the upper leg," Dr. A nghel says. " We then puncture a sma ll hole in the wa ll between the atria and pass the Watchman device to the LA A where it's deployed. Patients return home after one night in the hospital. Six weeks later, they come back for another TEE to assess how well the canopy of the device has covered and occluded the relevant area." A f t er t he si x-week T EE , t he va s t majority of patients stop ta king blood thinners and begin anti-platelet drugs for six months. A f ter 12 months, they have a third TEE to a ssess the f ina l out c ome of Wa t c h m a n pl a c ement . Drs. Anghel and Ahmed have implanted more than 75 Watchman devices since early 2018, with an impressive success rate: Nearly every patient has been able to abandon blood thinners at a duration procedure risk and rate of success a ll better than the nationa l averages. HIS BUNDLE PACING A potential complication of implanting a conventional pacemaker is that placing leads in the right ventricle of the heart can prompt contractions that are out of sync with those of the left ventricle. Over time, the resulting dyssynchrony can cause seri- ous complications, including heart failure. To avoid dyssynchrony, electrophysiolo- gists can implant pacemaker leads in a part of the heart's electrical conduction system called the bundle of His. Convenient Access to Care INDI V IDUA L S W HO LI V E north of Syracuse may have to drive up to several hours to reach the Heart Group of Syracuse's main location at 6700 Kirkville Road in East Syracuse. To ease the burden of travel on these patients, the Heart Group operates two satellite clinics in underserved communities north of the city. "We opened offices in Watertown and Fulton for the convenience of a large population of patients who find it difficult to travel to Syracuse, including individu- als from Vermont and Canada," says Traian M. Anghel, MD, FACC, cardiologist, cardiac electrophysiologist and Founding Partner of the Heart Group. "It's quite fulfilling to reach out to patients in the communities north of Syracuse, and they appreciate the ease of access to care. It is also an honor to be able to serve Fort Drum members of the military and their families close to their home." The Heart Group has been serving patients in Watertown at 1116 Arsenal Street, Suite 502, for nearly three years and in Fulton at 810 South First Street, for five. The offices are open two to four days a week depending upon the season, and the Heart Group plans to institute a full-time, five-day-a-week schedule at both locations in the future. " At the Heart Group of Syracuse, we have accumulated vast experience in cardiac and AP procedures. The literature shows high-volume implanters have considerably lower risk of procedural complications than average volume implanters. Just as we track our procedural volume, we also track our outcomes. Our risk of complications is well below the national average and all established standards." — TRAIAN M. ANGHEL, MD, FACC, CARDIOLOGIST, CARDIAC ELECTROPHYSIOLOGIST AND FOUNDING PARTNER OF THE HEART GROUP Traian Anghel, MD, FACC 0 8 0 8❱❱❱❱❱ C O V E R S T O R Y