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The Watchman Device

We talk about the increased risk of stroke quite a bit, both on this website and during consultation. The unfortunate truth is that for the millions of Americans suffering from arrhythmias, and especially Afib, the risk of stroke is exceptionally high, at over five-times that of someone without Afib. As a result, while we certainly want to improve the patient’s lifestyle and reduce their anxiety over having a future episode, our primary goal is to reduce the risk of stroke.

To understand the risk of stroke, we must understand the causes. Ultimately, the irregular and fast heartbeat associated with Afib can cause blood to pool in an outpouching of the heart known as the Left Atrial Appendage or LAA. Because the blood in this pouch is relatively stagnant, it can start to clot. If a piece of clotted blood breaks off and travels to the brain, it can cause stroke and death.

The Watchman device is a catheter-based occlusion system that looks much like a parachute, that when deployed fits snugly over the opening to the LAA. During the procedure, a small incision is made at the groin and the catheter containing the compressed Watchman device is threaded up a blood vessel into the heart. Using advanced imaging techniques, the device is deployed to maximize occlusion of the LAA. The entire procedure is performed under general anesthesia and takes about an hour. Recovery requires one night in the hospital, after which patients are discharged home.

While device placement itself offers immediately reduced risk of stroke, the heart forms scar tissue around this foreign object. The scar tissue further reinforces the barrier between the LAA and the rest of the heart and makes the lowered risk of stroke permanent. Implantation of the Watchman device can be performed alongside a cardiac catheter ablation or cryo-ablation to eliminate Afib as well.

Benefits of the Watchman Device

  • The primary benefit, of course, is to reduce the risk of stroke by occluding the LAA. Indeed, the Watchman has been shown to offer exceptional benefit in this regard and about 96% of patients no longer need to take anticoagulant medication.
  • The minimally invasive, catheter-based nature of the procedure is beneficial to the patient versus the open-heart procedures that may have been necessary in the past.

Risks of the Watchman

  • As with any interventional procedure, no matter how minimally invasive, there is risk of pain, blood loss and infection at the incision site. This is relatively rare and easily managed if it does occur.
  • Catheter-based interventions run the risk of damage to the blood vessel and the heart itself. Experience is key to managing this potential complication.
  • There is the very small risk of migration of the device, which would require immediate surgical intervention to correct. Fortunately, this is very rare.
  • Some, albeit very small, risk of stroke remains even after a successful Watchman implantation.

The bottom line

Left Atrial Appendage occlusion, whether performed using the Watchman device or the Lariat suturing procedure is very effective in managing the risk of stroke in Afib patients. We encourage you to speak with Dr. Niazi and Dr. Bisla to see if the Watchman is the best option for your particular circumstance. We look forward to schedule a consultation at our office for you to learn more about this and other interventions for arrhythmias.