Afib and watchman concerns

As we age, our blood pressure tends to rise. It's usually slow, usually not dangerous.......but it all depends on what else is going on in the same body. Often several 'issues' crop up at the same time, and failing to treat one makes successful treatment of the other much more difficult. Blood pressure can be successfully controlled with medication. For most of us, it's a fact of life if...........IF............we are incapable of, or not motivated to, control the other factors that make hypertension pretty much inevitable.

If the numbers you cite are typical for you, then they are in the 'hypertensive' range. I, my personal preference here, would not want to be in that range for long without some serious consideration of where I was headed and what could happen if I chose not to undergo any therapy.

You have had to cardioversions? Or two ablations? I'm not clear. If you have a pacemaker, those generally control the two largest chambers, the ventricles, but modern pacemakers can control both with more leads. Your pacemaker may need attention by an electrophysiologist, but you might still also benefit from a(nother) ablation if the focus for AF is in one of the atria. It's worth a consultation in my inexpert opinion.

@gloaming Isn't watchman installed concurrently with Ablation? Not sure Insurance will cover watchman install, Medicare seems not to cover but confusing:

"The CMS National Coverage Determination (NCD) remains unchanged. The patient must be deemed unable to take long-term OAC and meet all criteria in NCD 20.34 to be eligible for coverage"

OCEAN results seem to make LAA closure not needed post Ablation for most patients

I have similar issues with BP as bubbsy described. " Checking thyroid function is essential for individuals with unexplained or difficult-to-manage hypertension." I've noticed that my BP decreased significantly (140->120 and 90-75) since I lowered my levothyroxine dose which raised my TSH level. I've also found (repeatedly) that medical cannabis lowers my BP and helps me sleep better.

@chickenfarmer In some cases, yes, but in other cases, no. Depends on the individual case. Some elect not to have one, even if recommended, but later change their minds. Historically, the Watchman is meant to reduce the risk of a clot escaping from the LAA long after a successful ablation or long after a last recorded/known episode of AF. I'm talking about months later. Those who have rare episodes of AF that last less than two/three hours are at lower risk of clotting in the LAA, and they may never need or be offered a Watchman. Those in persistent AF episodes lasting a week, but which then resolve some time shortly thereafter) are at the full 5X risk, and they would benefit from a Watchman. However, that only accounts for the estimated 90% risk of a thromboembolic event related to clots escaping from the LAA. There's that other 10% unaccounted for, and which a DOAC should mitigate.

Those trials are interesting in their own rights, and who wouldn't hope that they're proven to be correct in time. One less thing to tinker with, one less expense, and less time under anesthetic. One less TEE in six months, and for some EPs who want a second one in a year's time before they'll agree their patient can forego a DOAC. Win, win, win.... But their authors are careful to say not to jump on any passing wagons just yet. More research needs to be done.