Watchman?

[Doug1941]

Been seeing TV ads for this device recently. I am always skeptical about medical adds on TV. Has anyone here had this procedure? Just curious. Have PA with episodes every year or so. MDs here in Canada won't prescribe meds for PA so need to go to ER for conversion... Thanks

[Jalia]

Hello Doug, I'm assuming by PA you mean paroxysmal Atrial Fibrillation?

The Watchman, I understand , is an Occlusion device used to seal off the left atrial appendage.

I'm having this procedure in 4 weeks time. I'm not sure yet which device is being used. I think it may be the Amulet device. The idea is much the same.

I'm having this done as the left atrial appendage was isolated incidentally during my recent (5th) ablation.

[Doug1941 in reply to Jalia]

Jala thank you for the reply. It's hard to tell from the advertising puffery. Yes I have PAF. I'm going to get an opinion from my Cardiologist in a few weeks.

Thanks again and take care

[Cookie24 in reply to Jalia]

My left atrial appendage was isolated during my third ablation two years ago. EP telks me this makes me a higher stroke risk. He recommends the Watchman. I read a few articles about Watchman problems. Please let us know how you do with your Watchman procedure. I am in USA

[Jalia in reply to Cookie24]

My LAA , as I mentioned, was also isolated at my last ablation 4 weeks ago. I was told the Occlusion device needed to be fitted quickly. I believe that the specialist uses the Amulet device. I don't expect to be given a choice as its NHS.

I'll post on here when I've had it done.....appt is 20 August or could be sooner.

[Goosebumps in reply to Jalia]

Hello. Could you please explain further what you mean the LAA being ‘isolated’ during the ablation, I’ve not heard that term before. Also did you mean ‘accidentally’ rather than ‘incidentally’? I’m very curious as to what happened during your 5th ablation. Thanks

[Jalia in reply to Goosebumps]

Hi, I did mean "incidental", it was no accident. It is actually the term used.

I had an epicardial ablation where entry is made through the chest wall ( as well as endocardially through both groins). I see from the report that " ablation was performed epicardially at the base of the appendage with isolation of the lateral left atrium".

Before I went into the lab my EP was explaining to me about the possibility of a 'plug ' needing to be inserted in a separate procedure so I'm assuming this was 'incidental ' ( having read up on this since...)

I'm having the Occlusion device fitted by a Cardiac Interventionalist ( Professor, no less) at the Cardiac Centre on 20 Aug. This is supposed to be an urgent procedure as with the LAA being isolated I'm at increased stroke risk.

Are you any the wiser ??!

[Goosebumps in reply to Jalia]

Many thanks Jalia. I’m always a bit wiser reading posts on this site but somehow wisdom eludes me!

I suppose that it’s natural to try and place procedures into boxes with known names so that we understand what they are, and your description seems to fit a hybrid surgical and catheter based procedure, but the word ‘isolation’ in the report didn’t really help me. Do they mean isolating electrical signals at the base of the LAA via ablation? I also wonder why they didn’t occlude the LAA while they had the opportunity, but there must be a good reason for this.

I’m heading down the road to a ‘Mini maze’, so really interested , because the LAA will be occluded at the same time.

[Jalia in reply to Goosebumps]

Re the actual placing of the Occlusion device I believe this is quite a specialised procedure and as such is done by an experienced interventionolist .I would think that isolation refers to the electrical signals.

This was not really a surgical procedure. A small incision was made under my left breast bone and a catheter threaded up through there. Not a mini maze procedure.

[Angie06]

Hi, I had this procedure here in the UK at Bart's 4yrs ago but with the Amulet device. Pretty much the same device but a different make with varying sizes. It was to seal off the left atrial appendage due to me not being able to take anticoagulants. I had it under GA ,it took 3.5 hours and went well with follow up TOE 12wks later. So far so good and has put my mind at ease regarding clots from that area.

[Jalia in reply to Angie06]

Hello Angie, I've noticed on my hospital letter that mine is being done under local anaesthesia. I had assumed it would be GA. I think I will check back with them! I'm quite happy with local ( I think...)

[Angie06 in reply to Jalia]

I'm not sure it could be done under local unless they've changed the method as mine was done via the groin up into the heart and through the heart wall into the left side. Definitely check with someone, maybe they've advanced the technique 😉

[Jalia in reply to Angie06]

I've had 3 ablations done by this method, through the groin up into the heart and accessed from right to left through septum and these were done with local anaesthesia plus light sedation. I will check though

[ozziebob]

I would investigate the safety aspects of these devices, as they are not without risks. I suggest you also look at the AtriClip, which is fitted on the outside of the heart rather than inside, and seems potentially a safer device. (PS. I have no such LAA closure device fitted, and am not financially interested)

Good luck.

[Cookie24 in reply to ozziebob]

My EP recommends Watchman. I did not know the AtriClip is on the outside. Do you have links to articles about this

[ozziebob in reply to Cookie24]

Good. You will need to discuss the risks with your EP. I have just read various research articles online about the procedures used and the risks involved to reach a preference for myself, and you could quickly do the same. I am interested in these devices because I'm currently not taking the DOAC I have been recommended, mainly because of my justifiable intracranial bleed fears from a previous event. But your situation will be different to mine. I have drawn the conclusion that the preference of device used, as well as being patient anatomy dependant, and associated procedure (if any) dependant, is also affected by the financial interests of the device manufacturers. You might "expect" this, but it's good to be aware of the situation.

Re my preferences, I am drawn to procedures that work on the outside of the heart, such as a minimaze and the atriclip, rather than those where the inside of the heart is accessed via catheters (which have their own unique risk profiles), such as a catheter ablation and the Watchman device.

[opal11uk]

Find it difficult to believe that in Canada you cannot be prescribed medication for A/F, my cousins live on Vancouver Island and as I speak to them every week I will ask them why????

[tooh]

Hi Doug. I had the Watchman device procedure about 5 years ago recommended and performed by a very experienced and competent EP in Australia. At that time it was relatively new here so of course i was very nervous and researched as much as i could before agreeing to it keeping in mind all risks.My reason for having this done was because

I had severe gastrointestinal bleeds due to anticoagulants and a high stroke risk.

I am now off all anticoagulants and asprin and not worrying about side effects of medications.

For me personally i believe this was the right choice for me at the time.

I would suggest you get the best EP you can find who is experienced in this procedure. Don't be afraid to ask them any questions you may have.

Best regards

[willywombat44]

I had the Watchman device fitted two and a half years ago in a 1 hour procedure under general anaesthetic. I am part of the Champion AF study to see if the LAAO procedure is more beneficial than a lifetime on Anticoagulation.No problems - so far!

[Sweetmelody]

I have a Watchman. Here are some of my reasons for proactively seeking and getting a Watchman:

I don’t want a stroke; I come from a family history of strokes. A Watchman gives me great comfort by closing off the place most blood clots form. Bleeding like a stuck pig from a minor insignificant wound is not pleasant, nor are hands with purple-blue splotches. I choose not to invite internal bleeding risk where otherwise there is none. I need access to pain relief nostrums (like aspirin) other than acetaminophen, and certainly do not want to turn to opioids. I choose not to become an overmedicated old lady lining up her pills two or three times a day. All drugs have side effects, including anticoagulants, such as life-threatening bleeding, or less significant bleeding such as nosebleeds and bleeding gums, and nausea or other gastrointestinal upsets to our body’s normal functioning.. The fewer the drugs, the better.

These are all personal decisions. I know you’ll make the right one for yourself.

I myself am delighted to have a Watchman.

[Doug1941 in reply to Sweetmelody]

Thank you for such a positive response. I'm seeing my Cardiologist in the next few weeks and will pursue with him.Doug

[Abbyroza]

There are a few EP’s who warn against this procedure. One of them is John Mandrola. This is his stance on the procedure:

“The PROTECT AF and PREVAIL trials, which compared the Watchman device to warfarin, did not show a reduction in ischemic strokes. In fact, the PREVAIL trial indicated a higher rate of ischemic strokes in the Watchman group compared to anti-coagulation.

Studies have found high rates of thrombus formation on the device, which contradicts its purpose as it requires patients to continue anticoagulation therapy, the very treatment it aims to replace.

There are significant complications associated with the implantation procedure, including a 6% average rate of serious complications, which he deems unacceptable for a preventive measure.

Mandrola criticizes the financial incentives for hospitals and physicians to use the Watchman device, suggesting that economic motivations should not override patient safety and evidence-based practice.”

In summary, Mandrola believes the Watchman device offers no significant benefit over anti-coagulation and poses substantial risks, and he does not recommend its use outside of clinical trials until more conclusive evidence is available.