I am being tested to see if I can receive a watchman. Any pros or cons

The watchman has a really good record of eliminating the risk of clotting in the left atrial appendage. Note that this assumes the competence of the physician/surgeon is high, and that the watchman seals really well, completely, and that there are no clots left in the process, and that there is zero blood flow as a result. This is determined by a TEE about six months after the procedure (trans-esophageal echocardiogram).

I have not had the procedure (my electrophysiologist replied to me when I asked that he finds that isolating the pulmonary veins has a generally good outcome by itself. His reasoning is that, if he succeeds in stopping the AF, there really is no need for the watchman; your heart will pump cleanly as it has always done, and you needn't worry about blood pooling and beginning to coagulate inside the appendage. You must work with your EP, naturally, and be very well prepared to counter any advice he/she offers if you don't like what you hear. Personally, I defer to them unless what they propose has little explanation to me...in which case I ask.) However, I have read of the accounts of many who have had the procedure, and they're perfectly fine, even grateful to come back to affibers.org forum and report that their procedures had gone well and that the follow-up TEE was perfect. Again, it's the skill and experience of the applying 'technician' that matters at least as much as the device or procedure itself. You want really competent, busy, and highly sought electrophysiologists.

For sleep apnea, you are probably like me....didn't know I had it until I developed AF. The very last test, of about six, was to go to a sleep lab over night, and that's when the bulb lit up. I have been on PAP treatment for seven years now. Never looked back.

I hope your own apnea is now well controlled.

John Mandrola, a well known and respected cardiologist/electrophysiologist is not a fan of the Watchman. You can read about his opinion on it here: https://open.substack.com/pub/johnmandrola/p/the-case-against-watchman-for-stroke?r=6vy81&utm_campaign=post&utm_medium=web

Dr. Anthony Pearson, “The Skeptical Cardiologist” is also not a fan: https://theskepticalcardiologist.com/2024/02/01/is-percutaneous-left-atrial-occlusion-cardiologys-greatest-error-beware-the-leaky-watchman/

I trust these doctor’s opinions and have even corresponded with Dr. Pearson. But you need to decide what’s best for you and make that decision in concert with your doctor. With my heart arrhythmia issues I’ve always chosen the most conservative path but that’s me, not you. I’m 73 and have paroxysmal afib and SVT (supraventricular tachycardia). The latter runs in my family but has not seemed to result in early death so I don’t worry too much about it, nor does my cardiologist. The Afib episodes only happened when I was under acute stress so that’s much easier for me to control, using mind/body and meditation practices. I take low doses of an extended release beta blocker to keep heart rate down and Losartan (an ARB) for blood pressure. I have flecainide as a pill in a pocket to take along with a regular beta blocker should I have another Afib episode. Because my Afib episodes have been so far and few between, if I have another Afib episode, once it stops, I agreed to take Eliquis for 5 days after the episode. This was decided in concert with my cardiologist.

Best of luck to you deciding what is best for you. Making decisions about our health as we age gets more complex doesn’t it?

A great many strokes from blood clots happen literally months after a single AF episode. This is why so many cardiologists and EPs don't want their patients eager to stop using DOACs to do that after their ablations and when the TEE shows no leakage if there's a watchman in place, or even when there isn't a watchman, but the patient is deemed to be free of PACs and other dysrhythmias. What they rely on is one's CHADs score...you can look that up. It's the standard in the electrophysiological and cardiology fields to determine who needs to be placed on a DOAC.

The best EPs in the country will agree that you can stop all medications related to controlling heart function once you have a successful ablation (one full year free of any AF), and have a watchman installed that is successfully 'seated', occluded by endothelial tissue, and that a 6 month post-ablation TEE shows no leakage.