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.