My point is, given that I tolerate the DOAC, that seems to put the Watchman in the elective category. I would love to stop taking Xarelto (I know I can stop anytime if I'm comfortable with the increased stroke risk)...I'm just not sure if, for me, the Watchman is worth the risks? Ugh!
My point is, given that I tolerate the DOAC, that seems to put the Watchman in the elective category. I would love to stop taking Xarelto (I know I can stop anytime if I'm comfortable with the increased stroke risk)...I'm just not sure if, for me, the Watchman is worth the risks? Ugh!
@nevets Okay, thanks...I see what you mean. I feel the risks of a Watchman installation are very low, about the same as the risk from any catheter ablation procedure....somewhere between 1-3% risk of an unfavourable outcome, depending on the patient and the protocols and 'readiness' of the team working on you. I honestly think the risk for an uncontrolled bleed on a DOAC runs about the same. The Watchman has a very good record in terms of a durable efficacy. And as with so many procedures and expectations, it once again falls to the skill and experience of the team doing it for you. If it works, if it remains leak-free, you are 'home free.' No DOACs, no repeats, and maybe a touchup ablation or two over the next 10 years if things go well.
I'm scheduled for the Watchman, assuming the CT scan shows that I am a candidate. However, I'm still on the fence about whether to go through with it. Here's why - I currently take Xarelto 20mg daily, which I tolerate well. But, I have an active lifestyle, bicycle riding, x-county skiing, hiking, furniture making (with power tools), cooking (with sharp knives), and more, all of which puts me at risk for bleeding. But the Watchman isn't a magic bullet. The procedure itself isn't risk-free, plus as some of these studies show, the device can leak and/or migrate over time, which may necessitate a more invasive procedure or the need to continue taking a DOAC. And who knows what the long term effects of a DOAC might be? Watchman or DOAC?...either path carries risks. While the doctor's recommend a DOAC based on my Chad score, they seem to regard the Watchman as elective surgery.
@nevets
From my reading of the atrial appendage closure device studies I think they have a limited role for very few patients. They leak a lot, people still get clots, the studies exclude procedural bleeding and the doac arm includes bleeding that may not be a clinical disaster. I’m a fan of John Mandrola at medscape.org. His writing and podcasts are said to be for healthcare professionals only since he assumes his audience understands a lot of technical stuff. He rips apart the stats and methods on a lot of studies and ticks off a lot of people. He talks about your situation in his most recent podcast. He is very critical of the watchman trials, I think he has a point.
@nevets
From my reading of the atrial appendage closure device studies I think they have a limited role for very few patients. They leak a lot, people still get clots, the studies exclude procedural bleeding and the doac arm includes bleeding that may not be a clinical disaster. I’m a fan of John Mandrola at medscape.org. His writing and podcasts are said to be for healthcare professionals only since he assumes his audience understands a lot of technical stuff. He rips apart the stats and methods on a lot of studies and ticks off a lot of people. He talks about your situation in his most recent podcast. He is very critical of the watchman trials, I think he has a point.
@diane987654321 recent studies conclude that DOACs do not reduce stroke risk in patients who’ve undergone catheter ablation and the numbers indirectly show no improvement for watchman recipients compared with those who don’t have watchman.
@diane987654321 recent studies conclude that DOACs do not reduce stroke risk in patients who’ve undergone catheter ablation and the numbers indirectly show no improvement for watchman recipients compared with those who don’t have watchman.
@chickenfarmer I’ve been following the no DOAC post ablation studies. I think the trick is to stay on a DOAC for a at least 9 months while doing frequent ECGs with a watch or other device and ideally a zio patch for 2 weeks before going off it. If no afib then I think no DOAC is smart. The issues I see with stopping DOAC is for people with severely enlarged left atriums or whose left atriums have poor strain numbers on echo. The scoring systems for DOACs don’t take that into account. I’m excited to see the pill in the pocket data for DOACs. I think a study might be coming out soon about that. I bought a used Apple Watch for $100 2 years ago and it has been decent for doing quick ECGs. I have a 6 lead Kardia and a wellue chest strap. None of the algorithms are accurate for my rhythm, I have too many PACs and I don’t have visible P waves in lead 1. The algorithms are good for most people though.
@chickenfarmer I’ve been following the no DOAC post ablation studies. I think the trick is to stay on a DOAC for a at least 9 months while doing frequent ECGs with a watch or other device and ideally a zio patch for 2 weeks before going off it. If no afib then I think no DOAC is smart. The issues I see with stopping DOAC is for people with severely enlarged left atriums or whose left atriums have poor strain numbers on echo. The scoring systems for DOACs don’t take that into account. I’m excited to see the pill in the pocket data for DOACs. I think a study might be coming out soon about that. I bought a used Apple Watch for $100 2 years ago and it has been decent for doing quick ECGs. I have a 6 lead Kardia and a wellue chest strap. None of the algorithms are accurate for my rhythm, I have too many PACs and I don’t have visible P waves in lead 1. The algorithms are good for most people though.
@diane987654321 In the studies there are some limits on the post ablation crowd not needing DOACs ie prior herat or stroke, high chad vasc score, etc. I was proxysmal so my EP put me on aspirin during the first year after ablation. I had a lot of PACs in 2024 but found that by adjusting my synthetic Thyroid hormone, most went away. For me Apple watch is sufficient for monitoring AF and PACs. I"ve also tried Galaxy and KArdia 2 finger sensor with similar results. None of these sensors call out PACs but if had enough the trace would be classifed as AF even though heart rate was 60-70 BPM. My EP poo pooed the diagnoses I showed him and told me not to worry about PACs but they were causing symptoms so I worked to stop them finally finding the Thyroid connection.
Think the latest studies (2026) have pointed out that Watchman stats have improved over time. But basically, IMHO still conclude that if one can handle NOACs without issue, to stay away from the procedure.
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My point is, given that I tolerate the DOAC, that seems to put the Watchman in the elective category. I would love to stop taking Xarelto (I know I can stop anytime if I'm comfortable with the increased stroke risk)...I'm just not sure if, for me, the Watchman is worth the risks? Ugh!
@nevets Okay, thanks...I see what you mean. I feel the risks of a Watchman installation are very low, about the same as the risk from any catheter ablation procedure....somewhere between 1-3% risk of an unfavourable outcome, depending on the patient and the protocols and 'readiness' of the team working on you. I honestly think the risk for an uncontrolled bleed on a DOAC runs about the same. The Watchman has a very good record in terms of a durable efficacy. And as with so many procedures and expectations, it once again falls to the skill and experience of the team doing it for you. If it works, if it remains leak-free, you are 'home free.' No DOACs, no repeats, and maybe a touchup ablation or two over the next 10 years if things go well.
https://www.sensible-med.com/p/champion-af-breaks-almost-every-rule
https://cardiovascularnews.com/laa-closure-blood-thinners-champion-af-acc-2026/
These are the two locations where I was reading about it. The first one is an opinion on the results by someone I follow. Neither article is lightweight in that you really need to like statistics to follow along. But if you have every considered getting a Watchman it's informative in weighting the pros and cons.
@nevets
From my reading of the atrial appendage closure device studies I think they have a limited role for very few patients. They leak a lot, people still get clots, the studies exclude procedural bleeding and the doac arm includes bleeding that may not be a clinical disaster. I’m a fan of John Mandrola at medscape.org. His writing and podcasts are said to be for healthcare professionals only since he assumes his audience understands a lot of technical stuff. He rips apart the stats and methods on a lot of studies and ticks off a lot of people. He talks about your situation in his most recent podcast. He is very critical of the watchman trials, I think he has a point.
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1 Reaction@diane987654321 recent studies conclude that DOACs do not reduce stroke risk in patients who’ve undergone catheter ablation and the numbers indirectly show no improvement for watchman recipients compared with those who don’t have watchman.
@chickenfarmer I’ve been following the no DOAC post ablation studies. I think the trick is to stay on a DOAC for a at least 9 months while doing frequent ECGs with a watch or other device and ideally a zio patch for 2 weeks before going off it. If no afib then I think no DOAC is smart. The issues I see with stopping DOAC is for people with severely enlarged left atriums or whose left atriums have poor strain numbers on echo. The scoring systems for DOACs don’t take that into account. I’m excited to see the pill in the pocket data for DOACs. I think a study might be coming out soon about that. I bought a used Apple Watch for $100 2 years ago and it has been decent for doing quick ECGs. I have a 6 lead Kardia and a wellue chest strap. None of the algorithms are accurate for my rhythm, I have too many PACs and I don’t have visible P waves in lead 1. The algorithms are good for most people though.
@diane987654321 In the studies there are some limits on the post ablation crowd not needing DOACs ie prior herat or stroke, high chad vasc score, etc. I was proxysmal so my EP put me on aspirin during the first year after ablation. I had a lot of PACs in 2024 but found that by adjusting my synthetic Thyroid hormone, most went away. For me Apple watch is sufficient for monitoring AF and PACs. I"ve also tried Galaxy and KArdia 2 finger sensor with similar results. None of these sensors call out PACs but if had enough the trace would be classifed as AF even though heart rate was 60-70 BPM. My EP poo pooed the diagnoses I showed him and told me not to worry about PACs but they were causing symptoms so I worked to stop them finally finding the Thyroid connection.
-
Like -
Helpful -
Hug
1 ReactionThink the latest studies (2026) have pointed out that Watchman stats have improved over time. But basically, IMHO still conclude that if one can handle NOACs without issue, to stay away from the procedure.