Living with a Watchman device

@grammycici I just want to be absolutely clear that, the instant your heart begins to beat in the chaotic tachyarrhythmia that is AF, your LAA begins to have a slower flush. In some, because no two LAAs are quite the same or found in quite the same place (that's why you have a TEE during an ablation or during an angiogram, sometimes, or other imaging prior to), the flushing will be so poor that your blood inside it may begin to congeal or to clot. Then, you gratefully lurch back into NSR and heavy a sigh of relief. But this is when your LAA begins to get flushed more consistently again, and this is when that clot gets blasted out into the main stream, through your mitral valve, and then up the aorta in the next beat or in the one after that. You can see the danger here. If I were in your shoes, I would want to know what my overall risk is for clotting based on age, other risks/comorbidities, etc, and then take into account that statistic of 'five times the risk of having a stroke when in AF.' The dislodged clot might happen inside of a couple of minutes, a couple of days, and the EP community wants you on DOACs for months after an ablation/Watchman installation because they have learned, the hard way, that clots can issue from the LAA weeks and months later. I know...it seems too bizarre to be true or possible, but you can't tell them that.

So, yes, even a few minutes in AF presents a real risk. Hours at a time even more. And then there's the problem of cardiomyopathy associated with that 9% burden you cited. It might not sound like much, but the literature suggests that somewhere between 3-8% is the demarcation point where you must stop the AF one way or another or risk having permanent remodeling of the heart. Enlargement, mitral valve problems, fibrosis in the substrate, and all the other things that can gang up and lead eventually, years later, to heart failure, a term I loath but which the meds continue to use.

You said you don't want to have a stroke. They know that! They don't want you to have a stroke either, and they don't want their friends, nurse and MD colleagues, judging them for not taking your risk seriously enough to insist that you take a DOAC or find another physician who will tell you what you want to hear.

I am sorry to sound 'strident' and rigid, hectoring you maybe. I take it as a duty to impart what I know to the discussions that the server highlites for my feed on this site, and heart health is the Big One for me. I'm not medically trained, but I know just enough to feel I MUST warn people about risks they may not understand or even know about. And, in the end, if you continue to trust your cardiologist and EP, you kinda have to listen to them and argue persuasively why you won't do as they ask you to convincingly.

Again, if my post sounds overbearing, forgive me.

Hi - Glad I found you! Searched for my issue but didn't find much. I had ablation and Watchman in June 2025. All good. Had TEE at 45 days and again a 365 days - both excellent. Got off the Eliquis and on the life-long aspirin. My problem is that I get nosebleeds - it was the major reason for seeking out the Watchman. I have to get my nose cauterized every time. Aspirin just makes them hard to control. EP approved 2 week aspirin pause (via portal) but I want more time, in part, it takes more than 2 weeks to fully heal and I also want to consult with rhinologist to augment what my ENT says. Anyone out there able to get permission to adjust the long-term aspirin protocol by reducing dose, or pausing for a bit to let things settle down? My EP seems very rigid though I know many are questioning the long-term aspirin mandate. All comments welcome!!!! Thank You.

@kcpdohn3333 Hi ! - So you are no longer on aspirin even though most people have to stay on for life? Fantastic. Did you have to push for that or was that your EPs' doing? I am having a hard time on aspirin but my EP is very reluctant to go against FDA and Boston Scientific guidance and there are no trials to show that "no aspirin" is okay. Any insights most welcome!

@pelion3484
Hello, in checking my posted comment I see that was written before my Pulse Field Ablation.
It was then what I understood would happen. Additionally I have installed within the last 5 years a Medtronic Azure Pacemaker (no shock kind) set to beat between 60bpm on low end & 130bpm on high end. my heart beat is monitored electronically by my EP’s office through my cellphone wherever I go. Comforting as they will call me if anything abnormal is noticed.
What my drug regimen the last year has been. Yes the hated 81mg of aspirin and Multaq 400mg twice daily. I take BP daily and that’s it.I complained about the bruising (81mg) aspirin causes and currently am on an every other day dose. It has helped the bad bruising be less severe. I don’t think I will ever be able to come off aspirin totally. Sorry I gave impression . I suppose Dr staff etc said that to convince me to install the Watchman. Overall, I have had no problems heart wise the last 2 years when I had last ablation
The pulse field one and a pacemaker adjustment by computer.. my life is my life again. The medical advice may be different now due to technology advances. All our hearts are different in many ways.
Am I glad I went through what was beginning to appear to be no solution and had all this done? BIG YES. My quality of life is back. Advice? Find an EP that has done many of these procedures and a large patient following. Good luck.

A couple months after I posted I was too afraid to try blood thinners, I landed in the hospital from a TIA with aphasia. Yes, that was scary so I’ve been on Eliquis for 10 months now with no issues. My afib episodes are now 60+ hours. The time goes up each year. They want to do an ablation and watchman now but I’m allergic to aspirin. So will I have to take Plavix for life? I thought it was just for a few months. What if I can’t tolerate that? Hmmm. Good to know everyone is pretty happy with the watchman.

@kcpdohn3333 Hi - Yes, I had an ablation and Watchman in 2025. Thanks for taking the time to comment. Your EP approved the every other day dose? That's very interesting and I am glad it helped reduced the bruising. I will have to ask about that approach. I know people do come off it for a surgery or procedure. My understanding is that in Europe - based on registry data - many EPs are more flexible about requiring long term aspirin. There is a new trial underway in Japan - NAPT-LAAC trial- that should all help answer this question. Best of luck to you!

@californiazebra Yes, happy with Watchman as I got off the Eliquis but not happy about the lifelong aspirin. No way I could do Plavix. After implant, I stayed on Eliquis for about 45 days, then TEE and then aspirin. Had ablation + Watchman at the same time.

@pelion3484
Thank you for your response. Glad you’re doing well. Did you take Plavix before? If so, how did it affect you?

Thanks for the comment. Never taken Plavix - too strong for me in terms of bleeding risk. Just stayed on Eliquis before after Watchman and then shifted to aspirin but I believe that is the protocol my EP uses for most of his patients. I think there was a study saying forgoing DAPT did not lead to more stroke and it did lead to less bleeding so EPs adapted their post-implant drug protocols.