What is the WATCHMAN™ device?
The WATCHMAN™ left atrial appendage (LAA) closure implant is a permanent heart implant used to treat atrial fibrillation (afib) not caused by a heart valve problem. With afib, the heart’s two upper chambers (atria) beat irregularly. An irregular heartbeat can result in slower blood flow in the heart, which can cause blood clots to form. They typically form in a small sac called the left atrial appendage. If a clot gets into the bloodstream and blocks blood flow to the brain, it can cause a stroke. Doctors typically treat people who have afib with a blood thinner called warfarin (brand name Coumadin) to prevent clots from forming and reduce the risk of stroke.
In 2015, the Food and Drug Administration approved the WATCHMAN LAA closure device for afib. It’s a parachute-shaped device that expands to the size of a quarter when implanted. The device has a mesh membrane that acts as a filter at the opening of the LAA to prevent blood clots from entering the bloodstream. After the nonsurgical WATCHMAN procedure, the device replaces the need for prescription blood thinners in most patients.
Why is a WATCHMAN implantation performed?
If you have an increased risk for stroke and have nonvalvular afib, but you aren’t able to take blood thinners because of side effects, compliance, or bleeding problems, your doctor may recommend mechanical LAA closure. While WATCHMAN reduces the risk of stroke in people with afib, there are risks to receiving a WATCHMAN implant. Talk with your doctor about whether the procedure is right for your situation.
Some studies show WATCHMAN device cost is comparable to 7 years of warfarin therapy and 16 years of non-warfarin anticoagulant therapy, but more studies are necessary.
Who performs a WATCHMAN implantation?
A cardiac electrophysiologist performs the WATCHMAN implantation procedure. A cardiac electrophysiologist specializes in treating heart rhythm problems, such as atrial fibrillation. In addition to specialty training for cardiovascular disease, this doctor also has board certification in the subspecialty of clinical cardiac electrophysiology. A cardiac EP performs electrophysiology tests (EP studies), makes diagnoses, prescribes medicine, and performs interventional (but not surgical) cardiac procedures to treat patients for arrhythmias. They work closely with other cardiologists who perform catheter-based cardiac diagnostic procedures and treatments for a wide range of heart conditions.
How is a WATCHMAN implantation performed?
You will have the WATCHMAN implantation procedure in an EP or cardiac catheterization lab where doctors can monitor the electrical activity of the heart. In general, the WATCHMAN implantation takes about an hour to complete.
What to expect the day of your WATCHMAN implant procedure
Once you are in the procedure room, your day will typically include these events:
A nurse will start an intravenous (IV) line to administer an anesthetic and any other medicines you may need.
The doctor will numb your groin area with an anesthetic and insert a catheter into a blood vessel.
The doctor will guide the catheter to your heart’s upper right chamber and then across the septum (the muscular wall that divides the two sides of the heart) to the opening of the LAA.
You may get a transesophageal echocardiography (TEE) imaging test to ensure the device is in the right place before implantation.
To permanently implant the device, the doctor will push the WATCHMAN out of the catheter into the opening of the LAA where it will open—much like a parachute or umbrella.
After the procedure is complete, you will stay overnight in the hospital.
You may need to have another TEE within 48 hours after the implantation.
After the procedure, heart tissue will grow over the implant within about 45 days. About this time, you will follow up with your doctor to make sure the device has sealed off the LAA and to discuss discontinuing blood thinner medications.
What are the risks and potential complications of a WATCHMAN implant?
As with many medical procedures, implanting a WATCHMAN device comes with some risks. These may include:
Bleeding due to heart catheterization
Serious bleeding due to the device, typically within the first six months
You can reduce your risk of complications by:
Informing your healthcare providers if you are allergic to anesthetics or have had complications from anesthesia in the past
Lying flat for several hours after the procedure to prevent bleeding at the catheter insertion site
Taking care to research the cardiac electrophysiologist carefully, considering his or her experience implanting the WATCHMAN device
Notifying your doctor immediately of any concerns, such as bleeding or pain
How do I prepare for a WATCHMAN implantation?
The team in charge of your care will give you detailed prep instructions well in advance of your procedure. To help the procedure go as smoothly as possible:
Don’t eat or drink after midnight the night before your procedure.
Ask your doctor what medications you’re allowed to be taking before the procedure and whether you should stop taking anything.
Tell your doctor about any allergies you may have, such as to an anesthetic or latex.
Make sure someone can drive you home when you’re ready to leave the hospital (usually the next day).
What can I expect after my WATCHMAN implantation?
Knowing what to expect makes it easier to plan and prepare for a successful recovery.
Most people can expect:
Short recovery time, but activity restrictions for about a week after the procedure.
No driving for 24 hours or longer after you leave the hospital.
Bruising where the catheter was inserted in your groin. If the insertion site bleeds, lie down and apply pressure to the area for several minutes.
You will need to follow up with your doctor as scheduled, likely around 45 days after the procedure.
When should I call my doctor?
Call your doctor if:
Your leg or foot becomes numb or turns blue, which may be a sign of a blood clot.
The catheter insertion site swells or drains fluid.
If bleeding from the insertion site won’t stop, call 911.
How will the WATCHMAN implant affect my everyday life?
The WATCHMAN device does not cure nonvalvular atrial fibrillation, but you may be able to stop taking blood thinners like warfarin if the LAA seals properly. It usually takes about 45 days. Your doctor may prescribe another blood thinner for a few months to make sure the implant is working properly.
With your doctor’s approval, you will eventually be able to stop taking all prescription blood thinners unless you need them to treat a different medical condition. Check with your doctor before you stop taking blood thinners. Your doctor may want you to continue taking aspirin every day.