Watchman Procedure ! Why aren’t we ?

[mjm1971]

Ok so

All AFIB sufferers allegedly have a higher risk of stroke .

So why are we not all having a Watchman fitted ??

Are they short term ?

Do they not work ?

Are they risky ?

Do they not last long ?

Surely we just all get one fitted

[Hidden]

As I understand it, there have only been a few procedures in the UK whereas more have been carried out in the States. Here, patients would only be considered for the procedure if it been proven that the patient had genuine medical reasons for not being able to take anticoagulants. I guess the powers that be consider that anticoagulants provide a cost effective, safe and successful solution to protecting patients from the risk of stroke. Fitting a watchman device is certainly not risk free, I believe risk levels are higher than those associated with having an ablation and we all know that having an ablation scares the pants of many. Does it work, well it’s a procedure which does not come with a guarantee because although it should seal off the area where most blood clots form, they can still form elsewhere and cause a stroke. So methinks it’s going to be a case of keep taking the tablets.

To put it another way, there are 1.5 million people with AF in the UK alone and the majority will need to be anti coagulated. It’s a guess, but say the procedure costs £20,000, I’ll let you do the maths but I think it will go some way to answering your question……..😉

[BobD Volunteer]

I think the simple answer is that they are costly but there may be medical reasons why they are not generally avaliable here in UK.

I do know that a trial here a couple of years ago was halted early.

The whole question of the left atrial appendage (LAA) is complex and whilst is is believed that clots do often form in that area I don't,think that is their exclusive domain. Various procedures such as Lariate have been tried to remove the LAA by keyhole trans-thoracic operations but other specialists think that the LAA has important function in such as blood pressure control.

I think that one or two centres may still be prepared to install an occlusion device such as Watchman if a patient has strong medical reasons why antiocagulants can not be taken but not just because a person finds tablets a nuisance.

[meadfoot]

A relative of mine was fitted with a watchman device during her valve repair and was told it was not fool proof and it depended where a clot appeared as not all Af clots are contained in the LAA.

It would cost a fortune to fit everyone with a device not to mention the bodily trauma of surgery and theatre resources. Certainly the NHS would not be able to undertake such a vast investment when there are effective drugs as alternatives. Given resources are so tight and life saving cancer drugs etc etc are often not given the funding they deserve then a watchman device for everyone wouldn't get past first base as a afib stroke solution.

[mjm1971]

Strokes cost the government £7billion a year . There are 1.5 million known Afib sufferers in Uk This op would cost no more than £10k each on NHS ( if that )

So NHS cost £1.5 billion to get rid of 30% of stroke victims

[Hidden in reply to mjm1971]

I think you need to bear in mind that folk with AF probably account for a relatively small number of overall number of strokes which can be caused by a whole variety of non AF related health issues. I’m no medical expert nor am I an accountant but I’m not sure your financial justification stacks up.

[Jetcat in reply to Hidden]

Google point flapjack.

[mjm1971]

Sorry all don’t I didn’t want want this to be political or anti NHS . They all do a brilliant job

[CDreamer in reply to mjm1971]

I don’t think it political at all, it’s whether or not medically the end justifies the means and in this case it’s not proven and for most people, not wanted.

[Hidden in reply to mjm1971]

Not a problem mjm, it’s a very reasonable question. Many here are concerned about the thought of taking an anticoagulant although the majority tend to come to terms with it in the end. I’m sure anybody would want to consider feasible alternatives but this and natural remedies are not likely to fit the bill……

[dmack4646]

The evidence that they work is far from compelling as Dr John Mandrola has demonstrated

[CDreamer]

I wouldn’t, even it was offered for the following reasons:-

It’s an invasive procedure, all invasive procedures carry risks - for me the risk of sedation and GA are quite high.

The purpose and function of the left atria appendage is not fully understood so the longer term affects of closing off the opening is unknown. There is a little research and as Bob pointed out, some specialists believe it has an important but not understood function.

It’s not foolproof as it’s not really known where clots in the heart for AF’ers form as that may be dependant upon the texture of the lining of the heart - smooth = good flow, rough as in a fibrous atria = disrupted flow meaning higher chance of blood pooling and clotting.

With any procedure there are risks and benefits which need to be assessed and for a procedure to be generally accepted and paid for - there are also economic reasons as highlighted by FJ.

To adopt or deny a procedure in the UK there has to be acceptance by NICE that the procedure is not only affective but economically worth the investment in prolonging life or improving quality of life and for those reasons LAA closure procedures are only offered when a person is unable to tolerate anticoagulants for medical reasons and the risk of stroke is high.

This is the NICE recommendation:-

Do not offer LAAO (left atrial appendage occlusion) as an alternative to anticoagulation unless anticoagulation is contraindicated or not tolerated.

[Smileyian]

My EP is a Watchman expert. Yes they do block the Left Atrial Appendage from blood pooling and forming clots. BUT the procedure does not stop AFIB - however does reduce the liklihood of strokes, but so does a modern Anticoagulant hence people may think a surgical procedure is not worth while as it has risks. It is an individual choice.

[Buffy-1 in reply to Smileyian]

Thank you for this information. I was wondering if the Watchman stopped afib.

[Chris147]

Stick with the warfarin and home testing which is brilliant my present for retiring to me. Keep well everyone

[mjm1971 in reply to Chris147]

Hi Chris , what home testing area you referring to ?

[Dazno]

Watchman devise is good

[Jajarunner]

They do offer them to people who struggle with anticoagulants such as people with the genetic disorder HHT. But it has its own risks and is irreversible and expensive.

[bikergurl]

It so happens, I had a cardiology appointment yesterday, and we had a discussion about the Watchman procedure. I live in the states, and it is more common here. My cardiologist said they are doing around 3-7 per week. As stated by others, patients who can’t be on anticoagulants, or don’t wish to be, are candidates. Not all anatomy is alike, and approximately 4% cannot have the placement, and unfortunately, that is only determined in the midst of the procedure.

[Shemac52]

At the moment I am waiting to hear from my EP after a MDT meeting to discuss whether I am a suitable candidate for Left Atrial Appendage occlusion . Would be good to meet my EP and discuss directly.I had a stroke after my OHS when on Warfarin and a TIA while on Apixban. In and out of AF so will have ablation at the same time,

[Madscientist16]

In the US, you need to find a surgeon who does it and then convince your insurance to pay for it.

[Pamuella]

Since having phizer jab Afib has changed I had it for ten years every couple of days sometimes lasting three days each time so felt I had it all the time. Since jab none in the day just a little flutter in the night, I do not understand this

[Jjda]

I live in the US and just this week, the research department at the local hospital called me and offered me the opportunity to get in on a research project being done nationwide on the Watchman vs NOAC treatment. Up until now, my local EP group has been doing about 7 Watchman procedures a week, mostly in those individuals who can"t tolerate anticoagulants, or have had a history of serious falls and bleeding due to ACs. This study is being done by a company that makes the Watchman devices, which right off the bat made me a bit skeptical, but I asked for the material to review. I received all the material and, although I absolutely hate taking Eliquis, I think I am going to pass on the Watchman, due to the risk of surgery, the lack of understanding as to the function of the LAA, and the possibility that I still might have to take anticoagulants if the device does not fit correctly.