Dr John Mandrola and his views on Watchman

healthunlocked.com/afassoci...

Bagrat started an interesting thread 3 months ago ( see above). I see the Watchman device as an excellent alternative to AC for elderly patients, the group who are most at risk from AC I would think.

Does Dr Mandrola have any standing, or is he a lone voice playing devil's advocate?

I believe funding in the U.K. for the procedure is limited. I believe costs are in excess of £10,000 including £3,000 for the device which seems a lot. Has anyone in the UK had one put in on the NHS? If yes have you been happy with the outcome?

BobD made an important point in Bagrat's post about clots coming from elsewhere in the LA, not just the atrial appendage, particularly after ablation(s) have been performed.

It seems to me that if long term data proves that Watchman provides the hoped for protection from stroke, then many of us will be pressing to have one as we reach old age, in order to give up AC.

[Hidden]

There are some forum members in the UK who have a Watchman but they are I think people for whom anticoagulation is unsuitable rather than those who are becoming less suited to it. I know rosyG had a speaker at one of her meetings talking about LAAO.

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I never thought I would see an EP talking like a geriatrician, thanks for the link. His book "The Haywire Heart" looks interesting too.

[MarkS]

Thanks goodness we have people like Dr Mandrola who can question the results churned out by the drugs industry/equipment manufacturers rather than taking them at face value.

Another more recent paper he has written is here:

medscape.com/viewarticle/89...

[KMRobbo]

I believe that John mandrola has PAF himself possibility brought on by endurance cycling. Probably gives him a different view to a lot of other doctors.

[Buffafly]

One downside of the Watchman (type) device is that it seems you have to take baby aspirin afterwards, but I would much rather take anything rather than aspirin which had dreadful side effects for me, so I wouldn't see it as a regular alternative to anticoagulants.

[EngMac]

This one on "In Afib, Shape May Matter" may be of interest. I am not aware that during an echo that this is even determined. I just had an echo and at the follow-up appointment with the cardiologist I will ask if this was determined for me. I once asked the Afib nurse and she told me "Oh, we don't look at this." Apparently, some hearts don't have left atrial appendage. Seems to me I also read somewhere that there is a right atrial appendage. Maybe someone can confirm this. Chicken wings are apparently not only good to eat, but chicken wing LAA's could mean you have less likelihood of stroke.

medpagetoday.com/cardiology...

[Hidden in reply to EngMac]

Great article. Thank you. Pity the AC status was unknown, that does seem to be a fundamental weakness in the study. The original paper linked below is from 2012. I wonder whether further studies have confirmed these findings.

Has anyone here had an MRI for LA shape?

Like the LASC score I posted about a few days ago, this could be an important tool in deciding whether to stop AC.

onlinejacc.org/content/60/6...

[Martin32]

Saw dr Greg Lip yesterday and asked about it and he said you are better with meds due to complications and it can stop eight out of ten clots but as for the other possible 2 would not protect