From the Guidelines
The Watchman procedure is a minimally invasive heart surgery that reduces stroke risk in patients with atrial fibrillation who cannot take blood thinners long-term. During this procedure, a small, parachute-shaped device is permanently implanted into the left atrial appendage (LAA) of the heart, where most stroke-causing blood clots form in atrial fibrillation patients. The device effectively seals off this area, preventing clots from escaping and traveling to the brain.
Key Points
- The procedure is performed under general anesthesia and typically takes about an hour, with patients usually staying in the hospital overnight.
- After implantation, patients take blood thinners for about 45 days until the device becomes fully incorporated into the heart tissue, after which most can discontinue long-term anticoagulation therapy.
- The Watchman works by addressing the root cause of stroke in atrial fibrillation - approximately 90% of stroke-causing clots in these patients originate in the LAA, and by closing this area off, the device provides a non-pharmaceutical alternative to blood thinners for stroke prevention.
- According to the most recent study 1, the Watchman device has been shown to be non-inferior to warfarin in preventing stroke in patients with atrial fibrillation, with a significant reduction in the risk of stroke and systemic embolism.
- However, the procedure is not without risks, and serious complications can occur, including pericardial effusion and procedure-related ischemic stroke, with a reported rate of about 7% 1.
- The use of the Watchman device may also reduce stroke risk in patients with contraindications to oral anticoagulation, although more studies are needed to confirm this 2.
Considerations
- The decision to undergo the Watchman procedure should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history.
- Patients should be carefully selected and evaluated for the procedure, and informed consent should be obtained after discussing the potential benefits and risks.
- Further studies are needed to fully understand the benefits and risks of the Watchman procedure and to determine its optimal use in clinical practice.
From the Research
Overview of the Watchman Procedure
- The Watchman procedure is a left atrial appendage occlusion device used to prevent stroke in patients with atrial fibrillation 3, 4, 5, 6, 7.
- Atrial fibrillation is a common sustained dysrhythmia that increases in prevalence with age and is associated with strokes that can lead to significant patient morbidity and mortality 3.
Indications for the Watchman Procedure
- The Watchman device is an option for patients with contraindications for anticoagulation 3.
- It is also considered for patients with end-stage renal disease, prior intracranial hemorrhage, recurrent gastrointestinal bleeding, and patients undergoing transcatheter aortic valve replacement or left atrial electrical isolation 4.
Benefits of the Watchman Procedure
- The Watchman device provides a significant reduction in life-threatening bleeding compared to oral anticoagulation (OAC) 4.
- It reduces hemorrhagic stroke and mortality versus warfarin, but is inferior for ischemic stroke reduction based on randomized data 6.
Procedure and Device-Related Complications
- The Watchman device is a percutaneously deployable device that can abate the need for continued oral anticoagulation 5.
- Device-related thrombosis is an important complication of left atrial appendage closure (LAAC), and the use of direct-acting oral anticoagulant (DOAC) for prevention and treatment of this complication remains unexplored 4.
- Management of device-related thrombus and peridevice leak remain unclear, and robust randomized data versus direct OACs are required before recommendations can be made for widespread adoption in OAC-eligible populations 6.