From the Guidelines
You will still be in atrial fibrillation (AFib) after Watchman device implantation, as the device is designed to reduce stroke risk by closing off the left atrial appendage, not to treat the AFib itself. The Watchman device has been shown to be effective in preventing stroke in patients with AFib, with a significant reduction in ischemic stroke or systemic embolism observed in the LAAOS III trial 1. However, this does not mean that the underlying AFib will be cured.
After implantation, patients are typically prescribed blood thinners like warfarin plus aspirin for about 45 days, followed by dual antiplatelet therapy for another 6 months, and then aspirin alone indefinitely, as suggested by regulatory approvals based on RCT protocols 1. However, real-world practice may vary, and some studies have proposed the use of direct oral anticoagulants or antiplatelet therapy without associated increases in device-related thrombosis or stroke 1.
It's essential to note that the Watchman device is associated with procedural risks, including stroke, major bleeding, device-related thrombus, pericardial effusion, vascular complications, and death 1. Additionally, device-related thrombi can occur, and follow-up screening for peri-device leaks is necessary, as small leaks are present in approximately 25% of patients 1.
Your heart rhythm management will continue separately with medications like beta-blockers, calcium channel blockers, or antiarrhythmic drugs as prescribed by your cardiologist. Some patients may still require procedures like cardioversion or catheter ablation to control AFib symptoms. The Watchman device serves as an alternative to lifelong blood thinners for stroke prevention, particularly beneficial for patients who cannot tolerate long-term anticoagulation, but managing the underlying AFib requires ongoing care and possibly additional treatments.
Key points to consider:
- The Watchman device reduces stroke risk but does not treat AFib
- Post-implantation medication regimens may vary
- Procedural risks and device-related complications are possible
- Ongoing heart rhythm management is necessary to control AFib symptoms
From the Research
Atrial Fibrillation After Watchman Device Implantation
- The Watchman device is a percutaneous left atrial appendage closure device that offers a new stroke risk reduction option for high-risk patients with non-valvular atrial fibrillation who are seeking an alternative to long-term warfarin therapy 2.
- The device is efficacious and safe in preventing stroke and systemic embolization, but it does not directly treat atrial fibrillation (AFib) itself 3, 4.
- After Watchman device implantation, patients may still experience atrial fibrillation, as the device only closes the left atrial appendage, which is the main source of thrombus formation in AF patients 2, 4.
- Some studies suggest that combining left atrial appendage closure with catheter ablation may be an effective treatment for atrial fibrillation, reducing both stroke risk and AF burden 5, 6.
- However, the Watchman device implantation alone does not guarantee the elimination of atrial fibrillation, and patients may still require ongoing management and treatment for their AFib 3, 4.
Post-Implantation Anticoagulation Management
- Post-procedural anticoagulation is needed to avoid device-related thrombosis, and the use of anticoagulants after Watchman implantation in patients with high bleeding risks has been a source of debate 3.
- The most often utilized regimen is warfarin followed by antiplatelet treatment, but in cases where there is a high risk of bleeding, antiplatelets alone may be sufficient 3.
- More research is needed to tailor the existing antithrombotic regimen to the needs of patients, and to determine the optimal post-implantation anticoagulation management strategy 3, 4.