Watchman Left Atrial Appendage (LAA) closure is a procedure performed to reduce the risk of stroke in patients with atrial fibrillation who are not a good candidate for long term blood thinners.
What is the connection between atrial fibrillation and stroke?
When patients are in atrial fibrillation, a clot can form in the left atrial appendage (located in the upper left chamber of the heart), which can then travel to the brain and cause a stroke. The majority of patients with atrial fibrillation are treated with blood thinners to prevent blood clots from forming in this area.
Why are patients referred for Watchman?
Blood thinners are the main treatment option to prevent stroke in patients with atrial fibrillation, but some patients cannot take long term blood thinners. The most common reason is excessive bleeding while taking blood thinners. Watchman is recommended for patients with atrial fibrillation at risk for stroke who are not candidates for blood thinners. Other considerations for Watchman are lifestyle factors such as a job where trauma to the brain is a potential concern (i.e. construction worker, professional athlete).
How is the procedure performed?
General anesthesia is used in all cases to ensure the patient is comfortable during the procedure. A small catheter (tube) is inserted into the femoral vein, which is a blood vessel near the hip. The Watchman device is then advanced through the femoral vein and up into the patient’s heart. The device is carefully advanced and positioned in the left atrial appendage. The device is then deployed in the left atrial appendage, which blocks off the appendage from the left upper chamber of the heart. After 45 days, a skin-like layer forms over the device, preventing clots from forming in this area.
After the procedure, most patients are monitored for 4-6 hours and sent home the same day. In some cases, patients are kept overnight for observation and discharged home the next day by lunchtime. Around 45 days after the procedure a final transesophageal echocardiogram (TEE) is performed to confirm the device has sealed the left atrial appendage; blood thinners can be stopped at that time and anti-platelet medication (baby aspirin) is continued indefinitely.
What is the recovery from a Watchman procedure?
After the procedure, patients lie flat for 4 hours to limit bleeding at the groin and can then sit upright in a chair. Patients are up and walking around the same day as the procedure and either discharged the same day or the following day.
After discharge, patients can resume everyday activities, including walking. We recommend no heavy lifting for at least one week to give the puncture site in the femoral vein time to heal. Bruising around the femoral vein site is normal, as a small amount of blood may leak out into the soft tissue. This blood will be totally recycled, but it may take 3-4 weeks for the discoloration from bruising to resolve. It is ok to shower, but we recommend avoiding a bath until the puncture site has healed, about 7-10 days.