In patients with atrial fibrillation who have experienced difficulties with blood thinners including significant bleeding, a Watchman device may be an excellent option. A Watchman is a small left atrial appendage closure device that covers or occludes the left atrial appendage, where the main risk of stroke occurs. The Watchman implant is delivered through a catheter, which then is guided to your heart through a large vein in your leg, similar to a heart catheterization procedure. The procedure to implant this device is known as a left atrial appendage closure procedure.
What is atrial fibrillation?
There are millions of patients throughout the United States living with non-valvular atrial fibrillation. Atrial fibrillation is the most common irregular heart rhythm, which can significantly increase a patient’s risk of stroke. A patient with atrial fibrillation is five times more likely to have a stroke then someone without atrial fibrillation, including an ischemic stroke.
Why is someone with atrial fibrillation more likely to have a stroke?
In atrial fibrillation, the upper chambers of the heart, also called the atria, are beating so fast that they are quivering, and as a result the blood is not flowing properly. This can then lead to stagnant blow blood flow, which could then result in a blood clot. Over 90% of blood clots formed due to atrial fibrillation occur in the left atrial appendage. The left atrial appendage is a small pouch in a person’s left atrium, or left upper chamber of the heart. This is where the main risk of stroke comes from in patients with atrial fibrillation; a blood clot typically forms in the left atrial appendage and then can travel in a patient’s bloodstream to the brain and give the patient a stroke.
Why is the Watchman Device used?
The Watchman device is an alternative to Warfarin and other blood thinner medications. This device ultimately reduces the risk of stroke in patients and can avoid the bleeding risks associated with many blood thinning medications. For decades, the main way to reduce risk of stroke in patients with atrial fibrillation was with blood thinning medications. There are many blood thinning medications currently available, the most common brand being Warfarin. By thinning a patient’s blood, these medications can significantly reduce a patient’s risk of stroke typically by 65-75%. Although these medications can be very effective in reducing risk of stroke, all these medications carry risks for major bleeding. Because of the risk for major bleeding, there are many patients who are unable to tolerate standard recommended blood thinners. Patients on blood thinners may have recurrent hospitalizations for significant bleeding or may develop significant anemia due to slow chronic blood loss. The Watchman device allows patients to cut down on their risk of strokes without suffering long-term effects of blood thinner use.
Patients typically stay in the hospital one night and are able to be discharged to go home the following day. Painkillers such as aspirin will be provided for the patient to take for post-surgery pain management. After receiving a Watchman device, the patient will still need to remain on blood thinners for about 6 weeks. This allows the Watchman device to be completely sealed off with the patient’s own heart tissue that grows over the device, which takes on average about 45 days. Over 90% of watchman patients are able to come off blood thinners 6 weeks post-procedure. Coming off blood thinners can significantly improve a patient’s risk for bleeding and anemia.
The Watchman device procedure has already been through clinical trials and has been FDA approved since 2015. It is minimally-invasive and is a one-time procedure. The Watchman device has been implanted in over 50,000 patients in medical centers worldwide. It represents an excellent option for stroke risk reduction in patients with atrial fibrillation, especially in patients who are unable to tolerate standard recommended blood thinners.
What are the possible risks of the procedure?
Like any medical procedure, the Watchman left atrial appendage occlusion does not come without its risks. The procedure is designed for patients with atrial fibrillation not caused by a heart valve problem. The procedure also involves being put under general anesthesia. Older adults with serious medical problems can be at-risk for complications under anesthesia. Boston Scientific lists other potential harmful events including valvular or vascular damage, cardiac perforation, air embolism, and more. The good news, however, is that the procedure is typically short, decreasing the time spent under anesthesia.
After the Procedure
The patient is expected to have a quick recovery after the procedure. The doctor will have the patient slowly weaned from their blood thinner medications as their body adjusts to the new device. To aid in recovery, be sure to record any changes to diet and exercise you make. Keep paperwork of any tests you go through during the recovery period. This information could be of importance to your doctor. Keep record of any medication you are prescribed to by your doctor post-surgery, and do not stop taking your medication unless your doctor suggests you do.
Following your procedure, you may want to take part in some low impact activities. You should be able to return to low level activity within just a few days after your procedure. Some low impact exercises include walking, cycling, utilizing the stairmaster machine, elliptical, swimming or water aerobics, strength training, yoga, and pilates. Be sure to ask your doctor about making changes to your diet and exercise.
Importance of a Heart-healthy Lifestyle
Following your procedure, you will be encouraged to continue your health journey with a balanced diet and exercise program. These things in conjunction with your new Watchman device can better assure that you will live a long and healthy life. Stop taking Warfarin and improve your quality of life. Schedule an appointment at Vital Heart and Vein and discuss with one of our excellent doctors if a Watchman device is right for you!
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