WATCHMAN Procedure for AFib: What to Expect Before, During, and After

Medically Reviewed By Uzochukwu Ibe, MD, MPH

The WATCHMAN is a device implanted into the heart to prevent blood clots in the left atrial appendage from entering the bloodstream. The WATCHMAN helps reduce the chance of stroke in people with atrial fibrillation. It is an alternative to long-term therapy with blood thinners.

This article explains the WATCHMAN in more detail, including who it is for, what the procedure is like, and what to expect afterward.

WATCHMAN explained

illustration of the watchman device in the left atrial appendage of the left atrium in the heart
The WATCHMAN device can close the left atrial appendage to help prevent blood clots in atrial fibrillation. Illustration by Bailey Mariner

With atrial fibrillation (AFib), the heart’s two upper chambers (atria) beat irregularly. This can cause blood clots. They typically form in a small sac called the left atrial appendage (LAA).

If a clot gets into the bloodstream and blocks blood flow to the brain, it can cause an ischemic stroke. Anticoagulants, or blood thinners, can reduce blood clot formation and the chance of stroke. Because they inhibit clot formation, blood thinners increase the chance of bleeding, including hemorrhagic stroke.

The WATCHMAN is an alternative to blood thinners. It closes off the LAA to reduce the chance of stroke. It is a mesh-covered metal device, about the size of a quarter. It looks like a tiny parachute. Once in place, it keeps blood clots from entering the bloodstream. The WATCHMAN replaces the need for prescription blood thinners in most people Trusted Source Food and Drug Administration (FDA) Governmental authority Go to source .

Why is a WATCHMAN implantation performed?

The WATCHMAN has Food and Drug Administration (FDA) Trusted Source Food and Drug Administration (FDA) Governmental authority Go to source approval specifically for people with AFib that is not due to a heart valve problem, such as rheumatic heart disease. The WATCHMAN may be an option if:

  • You have nonvalvular AFib.
  • You have an increased chance of stroke.
  • You can take blood thinners for a short period of time (45 days Trusted Source Food and Drug Administration (FDA) Governmental authority Go to source ). Although the WATCHMAN is an alternative to lifelong anticoagulation therapy, you need to take them for a period after the implant procedure.
  • You have a reason to seek an alternative method for AFib that does not require taking blood thinners for life.

Learn about the anticoagulant, warfarin (Coumadin).

What preparation is necessary for the WATCHMAN procedure?

You will undergo some tests before the procedure and consult with two doctors — one performing the implant and one not. This ensures you are a good candidate for the LAA closure procedure. Tests include a transesophageal echocardiogram (TEE) and CT scan.

A TEE is an echocardiogram. The doctor passes a tube with an attached transducer down your throat and into your esophagus. The esophagus is close to your heart so that the transducer can capture clear images of heart structures, including the valves and LAA.

A cardiologist with additional training in cardiac electrophysiology and cardiac catheterization implants the device.

How is a WATCHMAN implanted?

You will have the WATCHMAN implant procedure in a hospital. Doctors use cardiac catheterization — a technique that requires a small incision in your groin or arm — to guide it to the heart and implant it into the LAA. In general, the WATCHMAN implantation procedure takes about an hour.

Once you are in the procedure room, your day will typically include these events:

  • 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 and the opening of the LAA.
  • You will have a TEE to ensure the device is in the right place before implantation.
  • 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, heart tissue will grow over the implant within about 45 days. During this time, you need to take a blood thinner. 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?

The WATCHMAN procedure comes with some risks, some of which are life threatening. Discuss the potential complications with the doctor who will be performing the procedure. Ask what they will do in case they happen.

According to the device manufacturer, these risks include but are not limited to:

You may be able to reduce your chance of complications with these steps:

  • Inform your healthcare team if you are allergic to anesthetics or have had complications from anesthesia in the past.
  • Lie flat for several hours after the procedure to prevent bleeding at the catheter insertion site.
  • Confirm that your doctor has extensive experience implanting the WATCHMAN.
  • Notify your doctor immediately of any concerns, such as bleeding, pain, or difficulty breathing.

How do I prepare for the 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:

  • Ask your doctor what medications you can take before the procedure and whether you should stop taking anything.
  • Tell your doctor about any allergies, such as an anesthetic, metal, or latex.
  • Make sure someone can drive you home when you are ready to leave the hospital — usually the next day.

What can I expect after the procedure?

Most people can expect:

  • A short recovery time but with activity restrictions for about a week after the procedure. This means no heavy lifting, climbing stairs, cycling, running, strenuous housework, or sex.
  • No driving for 24 hours or longer after you leave the hospital.
  • Bruising where the catheter was inserted. 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.

Your care team will give you specific instructions for when to contact them or 911.

How effective is the WATCHMAN?

Cardiologists have compared the safety and effectiveness of the WATCHMAN to oral anticoagulants. Below is a summary of the findings. The WATCHMAN and other such devices are known as LAA closure (LAAC) or LAA occlusion (LAAO) devices.

Vs. warfarin and traditional anticoagulants

The WATCHMAN is more effective at reducing hemorrhagic stroke and less effective at reducing ischemic stroke. This is based on the 5-year outcomes Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source from two WATCHMAN clinical trials. Moreover, the rate of certain complications was lower for the WATCHMAN versus warfarin. These and similar results are what led the FDA to approve the WATCHMAN in 2015.

Vs. Eliquis

Apixaban (Eliquis) is a novel, or direct oral anticoagulant (DOAC). These types of drugs do not require frequent monitoring like warfarin. DOACs still carry a chance of bleeding events. Learn more about AFib medications.

A 2021 summary of a clinical trial shows that LAAO (WATCHMAN or Amulet) was similar to Eliquis for the primary result of the trial, which included bleeding events, stroke, transient ischemic attack, embolism, and cardiovascular death. With bleeding events alone, LAAO was better than Eliquis at preventing them.

More studies comparing WATCHMAN to Eliquis and other DOACs are necessary.

Combination treatment

There is some evidence Trusted Source The New England Journal of Medicine Highly respected journal, Expert written journal, Peer reviewed journal Go to source that combining LAA occlusion with anticoagulation therapy (traditional type or DOAC) is more effective at preventing ischemic stroke than either alone.

Talk with your cardiologist about the potential benefits and risks of WATCHMAN vs. anticoagulation therapy (or a combination of the two) for you.

Get tips for taking AFib medications.

What is the outlook?

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.

Check with your doctor before you stop taking blood thinners. Your doctor may want you to continue taking aspirin every day.

Other frequently asked questions

Below are some other questions that people tend to ask about the WATCHMAN.

Can I get the WATCHMAN if I don’t want to take a blood thinner?

Maybe. You may be a candidate for the implant if you have an increased risk of stroke and you have a reason for not wanting to take lifelong blood thinners. For example, blood thinners carry a risk of bleeding. There is also the cost of the medication.

How serious is the WATCHMAN procedure?

WATCHMAN is a minimally invasive but technical heart procedure. It is not like open heart surgery, but serious and life threatening complications are possible. These include excessive bleeding, embolism, thrombosis, and stroke.

How long does it take to recover from the WATCHMAN procedure?

You need to avoid intense physical activity or exercise for about 3 days after the procedure. Your doctor will discuss when you can return to work and other activities. The timing depends on your overall health and your type of work and activities.

Is the WATCHMAN better than Eliquis?

The WATCHMAN may not be as good as Eliquis for ischemic stroke, but researchers are still investigating. They know that the WATCHMAN is better than Eliquis at preventing bleeding in people with AFib who need to take an anticoagulant.

Summary

The WATCHMAN closes off the LAA to prevent blood clots from entering the bloodstream and causing a stroke. It is an alternative to taking oral anticoagulants for people with AFib. Clinical trials show it is safe and effective at preventing stroke. The procedure involves risk, so discuss its benefits and risks with your doctor before deciding on the WATCHMAN.

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  1. Bavry, A. A. (2021). Left atrial appendage closure vs. novel anticoagulation agents in high-risk atrial fibrillation patients - PRAGUE-17. https://www.acc.org/Latest-in-Cardiology/Clinical-Trials/2019/08/30/22/20/PRAGUE-17
  2. Chen, A., et al. (2020). Direct oral anticoagulant use: A practical guide to common clinical challenges. https://www.ahajournals.org/doi/10.1161/JAHA.120.017559
  3. Reddy, V .Y., et al. (2017). 5-year outcomes after left atrial appendage closure: From the PREVAIL and PROTECT AF Trials. https://www.sciencedirect.com/science/article/pii/S0735109717411879?via%3Dihub
  4. The WATCHMAN implant difference. (n.d.). https://www.watchman.com/en-us/how-watchman-device-works.html
  5. WATCHMAN left atrial appendage closure device with delivery system and WATCHMAN FLX left atrial appendage closure device with delivery system - P130013/S035. (2020). https://www.fda.gov/medical-devices/recently-approved-devices/watchman-left-atrial-appendage-closure-device-delivery-system-and-watchman-flx-left-atrial-appendage
  6. WATCHMAN, or Watch and Wait? (n.d.). https://www.umms.org/ummc/pros/physician-briefs/heart-vascular/atrial-fibrillation/watchman-or-watch-and-wait
  7. Whitlock, R. P., et al. (2021). Left atrial appendage occlusion during cardiac surgery to prevent stroke. https://www.nejm.org/doi/full/10.1056/NEJMoa2101897

Medical Reviewer: Uzochukwu Ibe, MD, MPH
Last Review Date: 2022 Aug 17
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