@devotion There is absolutely no need to do a confirmatory TEE more than once. Who told you it's 3-4 times? If it was an EP, find another....pronto. Run, don't walk.

I do agree that the installation of a Watchman imparts a risk of clotting and stroke all by itself. So, there might be an empirical argument for a DOAC to be taken when a Watchman is installed, although I have not gone looking or seen it. I can understand the reasoning, though. But the DOAC is meant to reduce the chances of a clot WHILE the LAA is either open or being sealed because clots can issue from the LAA for literally months after the last bout of AF. The usual protocol is to do a confirmatory TEE at about the six month mark, and some EPs might want a second another six months later if the first was 'inconclusive' or worrying. So, that's at most two, and again, not all EPs want the second. If the TEE shows no leakage, you almost certainly CAN go off the DOAC......provided.....there are no other/new reasons to stay on it. So, if you have another comorbidity, it might be wiser to stay on a DOAC. But if you're otherwise good, and the TEE shows you're not leaking, then most EPs will agree to let you go off a DOAC, maybe though to take a baby aspirin instead.

I have been on a couple of sites dealing with AF and its treatment for several years now, and I have seen all sorts of protocols described and prescribed. It depends on the EP, on the patient and what else is going on inside them, but I have never seen an anecdote where the poster says they've had more than two TEEs.

Perhaps I have misunderstood or missed something about your case. Is there more you can share publicly and willingly? I hope I haven't offended....