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Left Atrial Appendage Closure (Watchman)

The Watchman implant procedure is a surgery in which a small device is implanted into the heart to close the left atrial appendage (LAA). The minimally invasive, one-time procedure is designed to reduce stroke risk in people with atrial fibrillation (Afib).

In this way, it is an alternative to long-term blood thinners—medications that prevent blood clots. Clots form in the left atrial appendage (LAA). They can increase the risk of stroke.

Why choose Presbyterian for your left atrial appendage closure (Watchman)?

Presbyterian Heart and Vascular Care has a skilled electrophysiology team who can provide a wide range of cardiac rhythm treatments. Their electrophysiology cardiologists are trained in many different techniques and procedures, many of which can provide you with a shorter recovery period and the opportunity to recover at home.

Who is eligible for a left atrial appendage closure (Watchman)?

The Watchman may be appropriate when:

  • A heart valve problem does not cause atrial fibrillation.

  • People cannot take blood thinners because of a history of bleeding or risk factors for bleeding.

To determine whether Watchman is appropriate, doctors will evaluate your medical history and stroke risk. In addition, they will undergo a physical exam and a transesophageal echocardiogram (TEE).

The images from the TEE will show whether there are any existing clots and if the LAA is compatible with the size and shape of the Watchman. If clots are discovered, they may be treated with blood thinners before the procedure.

The Watchman device is not appropriate for patients who have:

  • Active infection.

  • Bleeding disorder.

  • A blood clot in the heart.

  • An LAA anatomy that will not accommodate a closure device.

  • Intolerance to the use of anticoagulation therapy, aspirin, or P2Y12 inhibitor.

  • An allergy to any portion of the Watchman device material or the individual component.

  • An atrial septal defect repair or closure device or a patent foramen ovale repair or closure device.

  • Too small-sized to accommodate transesophageal echocardiogram (TEE) probe or required catheters.

What conditions can be treated with a left atrial appendage closure (Watchman)?

The Watchman device is used to reduce the risk of stroke from clots formed in the left atrial appendage in patients with non-valvular atrial fibrillation.

How do I prepare for a left atrial appendage closure (Watchman)?

Your doctor will advise you about dietary restrictions, but you should expect to stop eating at midnight the night before your surgery.

It is important to talk to your doctor about any medications and supplements you are taking to avoid complications. Following the surgery, a blood-thinning medication will be prescribed for about 45 days or until the LAA is permanently closed off and heart tissue has grown over the implant to provide a barrier against blood clots.

You may want to ask someone to remain at the hospital with you before and after your surgery. You will need someone to drive you home after the procedure: you should not drive for at least 24 hours after having the procedure.

What should I expect during my left atrial appendage closure (Watchman)?

The Watchman procedure is done under general anesthesia, which means you will be asleep for the entire procedure. It takes about an hour, and patients usually stay one night in the hospital.

Before your surgery, you will be asked to change into a hospital gown.

Anesthesia will be administered via the IV inserted into the vein in your arm and monitored throughout the procedure. The surgeon will numb the groin area with an anesthetic and then insert a catheter into the upper leg's femoral vein. The surgeon will then guide the catheter to the heart and into the LAA.

The implant procedure is performed with fluoroscopy and TEE. The interatrial septum is crossed using a standard transseptal access system. A TEE imaging test may be performed before placing the implant to make sure its in the appropriate location. Once in place, the surgeon will push the Watchman out of the catheter, where it will open like an umbrella, about the size of a quarter.

After the procedure, you will be moved to a recovery room, where you will be monitored as the anesthesia wears off. A nurse will monitor your vitals and pain levels.

How do I care for myself after my left atrial appendage closure (Watchman)?

While the procedure is done so that people can stop taking blood thinners, you will continue to take a blood thinner for about 45 days after the surgery or until the LAA is permanently closed off. During that time, heart tissue will grow over the implant to provide a barrier against blood clots.

Although the Watchman procedure is minimally invasive, your body will still need time to heal. Follow up with your doctor as scheduled, usually around 1-2 weeks and then again at 45 days following the procedure.

Follow these precautions:

  • It is normal for some bruising and possibly bleeding around the groin area where the catheter was inserted. Tell your doctor about any unusual or significant bleeding.

  • You may be advised to abstain from heavy lifting while you heal. Talk to your doctor about when you can expect to resume normal activity.

  • Contact your doctor if you experience increased pain, are nauseous or vomiting, or have redness or pus at the incision site.

The Watchman procedure is an alternative to long-term blood-thinning medication. After your LAA permanently closes, you will be able to discontinue taking the blood thinner.